The efficacy of Gosyajinkigan for pollakisuria

We investigated the efficacy of Gosyajinkigan in 20 patients with prostatic disease, in whom pollakisuria was not improved by treatment with drugs for lower urinary tract symptoms. Four and 8 weeks after treatment, the urinary frequency was significantly improved during both daytime and night. The efficacy rates for diurnal frequency and nocturia were 45% and 65%, respectively. The International Prostate Symptom Score (IPSS) was decreased 4 weeks after treatment, and the parameters of uroflowmetry, the residual urine volume and quality of life score were improved 8 weeks after therapy. It was concluded that Goshajinkigan was effective for pollakisuria with prostatic disease, and the administration of the agent for 8 weeks or longer was needed to improve lower urinary tract symptoms.     

A population study of nocturia in Singapore

OBJECTIVE: To estimate the prevalence of nocturia in the multiracial Asian population of Singapore, using the new International Continence Society standardized definition of one or more voids per night, and to assess its associations, bothersomeness and impact on sleep. SUBJECTS AND METHODS: A door-to-door interview questionnaire survey was conducted amongst a randomly selected sample of 3000 individuals (response rate 78.2%). Nocturia and its associated problems were evaluated using questions from the International Prostate Symptom Score (IPSS), and concurrently, sociodemographic and health variables were recorded. RESULTS: Data from 1134 women (aged 20-95 years) and 1139 men (aged 20-92 years) were analysed; the overall prevalence of nocturia (one or more voids/night) was 55.5%, with an increasing proportion in older groups (P < 0.01). Women had nocturia significantly (P = 0.015) more often than men (58% vs 53%), and it was positively associated with poor health, with the highest odds ratios (95% confidence interval) for diabetes mellitus of 2.0 (1.3-3.1), for renal disease of 6.4 (2.3-18.2), and for strokes of 3.1 (1.1-9.2). In both men and women, the median IPSS in patients with nocturia was significantly higher than that in patients without nocturia (P < 0.001). For individuals waking once a night, only 9.5% considered nocturia a problem and 13.5% complained of sleep disturbances; these values increased to 36% and 40% for individuals waking up twice or more /night. CONCLUSION: Nocturia is a common condition amongst Singaporean adults, especially in the elderly; it has strong associations with poor health and other lower urinary tract symptoms. The degree of nocturia determines whether patients are likely to be bothered by it or have sleep disturbance, which will influence their help-seeking behaviour.     

Classification of nocturia in the adult and elderly patient: a review of clinical criteria and selected literature

Nocturia increases with age and significantly affects quality of life in both men and women. Attempts to determine the pathogenesis of nocturia have been based on frequency-volume charts, and three types of nocturia have been identified: low voided volume (previously termed low bladder capacity), nocturnal polyuria, and mixed origin. Validated clinical criteria based on frequency-volume data allow the type of nocturia to be specified using two threshold values, i.e. largest voided volume/body weight ratio <4 mL/kg for low voided volume; and nocturnal urinary output/body weight ratio >10 mL/kg for nocturnal polyuria. The utility of these thresholds was validated in a study of elderly patients with two or more nocturia episodes/night. Two other studies have improved the understanding of the epidemiology of nocturia. The first showed that in men and women, increased incidence with age was greater for nocturia than for the six other common lower urinary tract symptoms. The second study suggested that prostate changes in men (particularly bladder outlet obstruction caused by benign prostatic hyperplasia, which has been considered to be a major cause of nocturia) appear to play a relatively small role in the development of nocturia; the correlation was based on overall symptom score for seven common urological symptoms. Nocturia should thus be treated independently of other lower urinary tract symptoms, especially in men. The application of valid diagnostic criteria to differentiate the underlying cause of nocturia should help lead to more appropriate and effective management of this pervasive problem.     

Nocturia as a manifestation of systemic disease

Nocturia is commonly referred to urologists, but the mechanisms underlying the problem, together with the appropriate clinical assessment and management, may lie outside the ordinary scope of the specialty. Some serious conditions may manifest nocturia as an early feature, often as a consequence of nocturnal polyuria (NP). Voiding frequency is influenced by rate of urine output, reservoir capacity of the bladder, lower urinary tract (LUT) sensation and psychological response. Polyuria can result from polydipsia or endocrine dysfunction. NP can result from endogenous fluid and solute shifts, cardiovascular and autonomic disease, obstructive sleep apnoea, and chronic kidney disease. Nocturia without polyuria occurs in the presence of LUT pathology, pelvic masses and sleep disturbance. Drug intake can contribute to, or counteract, each of these problems. In assessing nocturia, clinicians need to consider an undiagnosed serious condition that may manifest nocturia as an early feature, or suboptimal management of a known condition. The frequency-volume chart is a key tool in categorizing the basis of nocturia, identifying those patients with global polyuria or NP, for whom involvement of other specialties is often necessary for assessment and management. Treatment should be directed at the cause of the problem, with a view to improving long-term health and health-related quality of life. Simple steps should be undertaken by all patients, including improvement of the sleep environment and behaviour modification. Evaluation of treatment response requires objective data to corroborate subjective impressions. Some mechanisms of nocturia do not reliably improve with treatment, leading to refractory symptoms.     

Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men

PURPOSE: We determined the normal value of diurnal and nocturnal voiding frequency, and its determinants in a population based sample of elderly men. MATERIALS AND METHODS: We collected data on 1,688 men 50 to 78 years old recruited from the population of Krimpen, The Netherlands. Measurements consisted of self-administered questionnaires, including the International Prostate Symptom Score (I-PSS), a 3-day frequency-volume chart, transrectal prostatic ultrasound, uroflowmetry and post-void residual urine volume measurement. RESULTS: Diurnal voiding frequency is independent of age and more frequent in men with benign prostatic hyperplasia (BPH). Nocturia 2 or more times is present in 30% of men 50 to 54 and in 60% of those 70 to 78 years old, while nocturia 3 or more times is present in 4% and 20%, respectively. In addition, nocturia is strongly associated with BPH and nocturnal polyuria but apparently not with cardiovascular symptoms, hypertension or diabetes mellitus. We noted poor agreement of the responses on the frequency-volume charts and the I-PSS question on nocturia. Using the I-PSS leads to a higher prevalence of nocturia. CONCLUSIONS: Diurnal frequency is independent of age (median 5 voids, interquartile range 4 to 6) but higher in men with BPH. Nocturia increases with advancing age and is more frequent in men with nocturnal polyuria. BPH is an independent risk factor for nocturia and increased diurnal voiding frequency. In those with nocturia there is a great difference in subjective symptoms and objective data, indicating that the weight of the I-PSS question on nocturia for making treatment decisions should be reconsidered.     

Nocturia and polyuria in men referred with lower urinary tract symptoms, assessed using a 7-day frequency-volume chart.

OBJECTIVES: To investigate if a 7-day frequency-volume (FV) chart could identify nocturia on a polyuric basis in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The study included 23 patients (mean age 62.8 years, range 42-78) with LUTS who were referred for the evaluation of potential BPH and 11 men (control subjects, mean age 63.3 years, range 58-69); all completed a 7-day FV chart investigation as outpatients. RESULTS: Nocturia was associated with nocturnal polyuria in 10 of 23 patients with LUTS; these 10 patients had a diminished diurnal variation of urine production, whereas 13 patients had a diurnal variation in urine production comparable with that in controls with no nocturia. The degree of nocturia correlated positively with nocturnal urine production but showed no relationship with sleep duration. The nocturnal polyuria in these patients was associated with a higher 24-h urine production and seemed at least partly to be caused by a higher fluid intake during daytime. CONCLUSION: Nocturia on a polyuric basis can be detected by using a FV chart. In these patients, a 3-day FV chart would be sufficient to detect nocturia on a polyuric basis and seems therefore to be a valuable tool in evaluating patients with LUTS referred for potential BPH.     

Melatonin pharmacotherapy for nocturia in men with benign prostatic enlargement

PURPOSE: Nocturia is a common condition often attributed in aging men to benign prostatic enlargement. Older adults are prone to nocturnal sleep disturbance, of which disturbed circadian rhythm may be a component since it improves with nighttime administration of melatonin. This study was designed to investigate melatonin as a potential treatment for nocturia associated with bladder outflow obstruction in older men. MATERIALS AND METHODS: A total of 20 men with urodynamically confirmed bladder outflow obstruction and nocturia were entered into a randomized, double blind, placebo controlled crossover study assessing the effect of 2 mg controlled release melatonin at night on nocturia. Symptoms were assessed at baseline and after each 4-week treatment period using a frequency volume chart, the International Prostate Symptom Score and symptom problem index. Maximum urinary flow rate and post-void residual urine volume were also assessed. RESULTS: Baseline frequency of nocturia was 3.1 episodes per night. There were 7 men (35%) with detrusor overactivity and 10 (50%) had nocturnal polyuria. Melatonin and placebo caused a decrease in nocturia of 0.32 and 0.05 episodes per night (p = 0.07) and a decrease in the nocturia bother score of 0.51 and 0.05, respectively (p = 0.008). Nocturia responder rates (a reduction from baseline of at least -0.5 episodes per night) differed between the active medication and placebo groups (p = 0.04). Daytime urinary frequency, International Prostate Symptom Score, relative nocturnal urine volume, maximum urinary flow rate and post-void residual were unaffected by melatonin treatment. CONCLUSIONS: Melatonin treatment is associated with a significant nocturia response rate, improvement in nocturia related bother and a good adverse effect profile. However, it is uncertain whether the observed changes in this study are clinically significant.     

Nocturia

Nocturia is a poorly understood symptom complex. It is seldom the result of obstructive lower urinary tract symptoms alone. Its association with multiple medical comorbidities and nocturnal polyuria explains the generally poor response to interventions aimed at improving outflow obstruction or lessening the impact of bladder instability. Nocturia is increasingly recognized as a surrogate marker for poor health and one that carries with it an increased risk of mortality. The management of nocturia needs to address not only the underlying medical conditions, but also the impact of nocturnal polyuria – the latter through anti-diuretic pharmacology or by manipulating the timing of an individual’s diuresis to avoid periods of sleep. Those interventions which increase the time before the first wake to void in an individual with several episodes of nocturia should be deemed of greater clinical significance than those that simply reduce the total number of voided episodes. In this respect an understanding of the restorative function of deep slow-wave sleep should not be underestimated. A failure to understand the fundamental causes of nocturia frequently results in an ineffective polypharmacy which further impacts on the quality of life in a predominantly senescent population.     

Nocturia

Nocturia is a poorly understood symptom complex. It is seldom the result of obstructive lower urinary tract symptoms alone. Its association with multiple medical co-morbidities and nocturnal polyuria explains the generally poor response to interventions aimed at improving outflow obstruction or lessening the impact of bladder instability. Nocturia is increasingly recognized as a surrogate marker for poor health and one that carries with it an increased risk of mortality. The management of nocturia needs to address not only the underlying medical conditions, but also the impact of nocturnal polyuria – the latter through antidiuretic pharmacology or by manipulating the timing of an individual's diuresis to avoid periods of sleep. Those interventions which increase the time before the first wake to void in an individual with several episodes of nocturia should be deemed of greater clinical significance than those that simply reduce the total number of voided episodes. In this respect an understanding of the restorative function of deep slow-wave sleep should not be underestimated. A failure to understand the fundamental causes of nocturia frequently results in an ineffective polypharmacy which further impacts on the quality of life in a predominantly senescent population.     

Urodynamic findings in patients with nocturia and their associations with patient characteristics

IntroductionThis study identified associations between lower urinary tract pathology confirmed on urodynamic testing, baseline characteristics, and symptoms for adults with nocturia. Nocturia frequency was examined for predictors.MethodsThis retrospective study from 2012–2019 analyzed adult patients with nocturia (waking to void ≥2x/night) referred for urodynamic testing (UDS). Data on baseline characteristics, symptoms, UDS parameters, and lower urinary tract pathology were recorded. Males and females were analyzed separately, and univariable analyses were conducted, stratified by lower urinary tract pathology. Multivariable regression models were fit. Nocturia frequency was analyzed for associations with clinical parameters.ResultsAltogether, 372 patients were included (159 men and 213 women). More men had detrusor overactivity (DO) (p<0.001) and bladder outlet obstruction (BOO) (p<0.001). DO was associated with storage symptoms (odds ratio [OR] 5.19, p<0.001), in addition to older age (p=0.009) and being male (p<0.001). Detrusor under-activity (DU) was associated with voiding symptoms (OR 1.92, p=0.004), older age (p<0.001), and being female (p=0.018). BOO was associated voiding symptoms (OR 2.09, p=0.023), younger age (p=0.018), and being male (p<0.001). The quantity of lower urinary tract symptoms was associated with DU and DO. Nocturia frequency was not associated with baseline variables or underlying pathologies. A substantial number of patients were diagnosed with DU alone (n=69, 18.7%) or associated with other diagnoses (n=108, 29.3%).ConclusionsCareful assessment of risk factors and symptoms may help identify underlying lower urinary tract pathology for adults with nocturia. DU is found in a significant proportion of patients with nocturia, a previously under-reported result.

KEY MESSAGES

• In adults presenting with nocturia for urodynamic testing, storage and voiding lower urinary tract symptoms (LUTS) may help differentiate underlying lower urinary tract pathology.
• The quantity of LUTS may increase the likelihood of being diagnosed with certain lower urinary tract pathologies.
• A substantial proportion of adults presenting with nocturia have underlying detrusor underactivity, a known underdiagnosed condition.

     

Nocturia

Nocturia is a poorly understood symptom complex. It is seldom the result of obstructive lower urinary tract symptoms alone. Its association with multiple medical comorbidities and nocturnal polyuria explains the generally poor response to interventions aimed at improving outflow obstruction or lessening the impact of bladder instability. Nocturia is increasingly recognized as a surrogate marker for poor health and one that carries with it an increased risk of mortality. The management of nocturia needs to address not only the underlying medical conditions, but also the impact of nocturnal polyuria – the latter through anti-diuretic pharmacology or by manipulating the timing of an individual's diuresis to avoid periods of sleep. Those interventions which increase the time before the first wake to void in an individual with several episodes of nocturia should be deemed of greater clinical significance than those that simply reduce the total number of voided episodes. In this respect an understanding of the restorative function of deep slow-wave sleep should not be underestimated. A failure to understand the fundamental causes of nocturia frequently results in an ineffective polypharmacy which further impacts on the quality of life in a predominantly senescent population.     

Fluid Balance Therapy of Nocturia in Women

Nocturia is a common and troublesome symptom in otherwise healthy elderly men and women. Nocturnal polyuria (an excessive nighttime urine output) has been documented to be a common finding in healthy men with lower urinary tract symptoms. It is also a presenting feature of various medical conditions, such as renal failure, hypercalcemia and diabetes. Fluid balance therapy is an option in those whose nocturia is secondary to nocturnal polyuria. If a reduction in fluid intake fails to reduce nocturnal frequency a variety of drug treatments may be beneficial. Several studies have confirmed the efficacy of intranasal DDAVP, a synthetic analog of antidiuretic hormone, in both healthy patients and those with neuropathic bladders, although fluid overload and hyponatremia are potential side effects. Other drug treatments include early evening diuretics, such as frusemide or bumetanide. More recently imipramine has shown therapeutic benefit in young adults with enuresis, and might prove to be useful in the elderly with nocturnal polyuria.     

Nocturia in patients with lower urinary tract symptoms: association with diurnal voiding patterns

OBJECTIVE: To determine whether diurnal voiding patterns predict nocturia in patients with lower urinary tract symptoms (LUTS), as few studies have evaluated the association between diurnal and nocturnal voiding patterns. PATIENTS AND METHODS: We prospectively analysed the frequency-volume charts (FVCs) of consecutive patients with LUTS. At the initial visit patients had a detailed clinical evaluation and subsequently were requested to complete a 72-h FVC. In all, 104 (41 men and 63 women, mean age 63 years, range 50-83) were included in the primary analyses. Associations between daytime variables and nocturia were described using maximum likelihood estimates of the relative risk and by 95% confidence intervals (CIs) based on logistic regression models. RESULTS: When at least one night-time void was used to define nocturia the multivariate logistic model showed a negative association of mean daytime voided volume with nocturia (P = 0.001). The odds ratio for nocturia decreased with this variable to 0.98 (95% CI 0.96-0.99). When 'voiding at least twice per night' was used to define nocturia only the number of daytime voids was positively related to nocturia (odds ratio 1.22; 95% CI 1.01-1.48; P= 0.040). CONCLUSION: Nocturia may be associated with diurnal voiding patterns; these results also suggest that the causes of nocturia of one or of two or more voids may differ. This highlights the role of bladder function in more severe forms of nocturia.     

Nocturnal Polyuria and Natriuresis in Male Patients with Nocturia and Lower Urinary Tract Symptoms

Purpose

We investigated the circadian variation in urine output, plasma angiotensin II, aldosterone, atrial natriuretic peptide, arginine vasopressin and blood pressure.

Materials and Methods

We studied 17 elderly men with nocturia and lower urinary tract symptoms, and 10 age matched controls without nocturia.

Results

Of the 17 patients studied 11 had a lack of diurnal variation in urine output and increased nocturnal urine production associated with increased nocturnal sodium excretion, and 6 had a diurnal variation in urine output comparable to controls.

Conclusions

Nocturia in a large proportion of elderly men with lower urinary tract symptoms in caused by nocturnal polyuria and natriuresis.     

Nocturia: the major problem in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO)

Nocturia is one of the most bothersome complaints in men with lower urinary tract symptoms suggestive ofbenign prostatic obstruction (LUTS/BPO). Storage symptoms such as nocturia interfere considerably with the patient's performance of daily activities and quality of life. So far little attention has been paid as to why nocturia is such a trouble for men with LUTS/BPO and their partners. It is increasingly believed that disturbed sleep due to frequent awakenings at night resulting in reduced daytime energy and alertness is the underlying cause of the interference with daily-life activities and the reduced quality of life. It seems that in particular awakening during deep sleep, i.e. during the first third of the night, results in increased sleep inertia (i.e. performance impairment immediately after awakening) and reduced daytime performance. It has been shown that the prevalence of frequent night-time voiding interfering with sleep and leading to poor sleep, feeling tired during the day and poor health increases with the number of nocturnal voids. Disturbed sleep not only leads to reduced productivity and increase in the number of sick days, but nocturia and disturbed sleep can also have serious health consequences with a dramatic impact on patients, their family and society. Sleep deprivation has a detrimental effect on somatic and mental health, and is implicated in accidents and even increased mortality. Therefore, it is important to know how LUTS/BPO treatment improves nocturia, reduces disturbed sleep and improves the overall quality of life of patients. Preliminary data suggest that LUTS/BPO therapy reduces nocturia and that a reduction in the number of nocturnal voids during treatment for nocturnal polyuria improves the hours of undisturbed sleep in the first third of the night, when deep sleep predominates. However, further research is required to more precisely assess the impact of LUTS/BPO treatment on nocturia, disturbed sleep and quality of life. The Nocturia Quality of Life (N-QOL) questionnaire which is adopted in the International Consultation on Incontinence modular questionnaire may be a useful tool for this.     

Nocturia in relation to sleep, health, and medical treatment in the elderly

Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24-h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3-4% in those aged >or= 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.     

Nocturia: impact on quality of life in a Dutch adult population

OBJECTIVE: To estimate the effect of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems. SUBJECTS AND METHODS: From a random sample of Dutch adults (>/= 18 years old) 1000 were selected after stratification to complete a written questionnaire. Respondents (819) were distributed over three groups: a target group (189, who felt bothered by >/= one void/night); a reference group 1 (120 reporting >/= two voids/night but with no bother); and reference group 2 (510, with 0-1 voids/night). Nocturia, other lower urinary tract symptoms and perceived impact on life were measured using the Bristol Lower Urinary Tract Symptoms Questionnaire (B-LUTS). Sleep problems were measured using the Sleep Wake Experience List (SWEL) and QoL using two subscales from the RAND-36, i.e. 'physical functioning' and 'mental health'. RESULTS: The perceived impact on life was highest in the target group (P < 0.05), which also had more sleep problems and scored lower on the QoL scores than both reference groups (P < 0.05). Statistically significant differences in mental health and physical functioning between the target and reference groups became insignificant after correcting for sleep problems, indicating that the effect of nocturia (with bother) is mediated by sleep problems. CONCLUSIONS: Nocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients who contact them for sleep problems also have nocturia.     

Pathophysiological aspects of nocturia in a danish population of men and women age 60 to 80 years

PURPOSE: We applied the International Continence Society Guidelines and categorized men and women with nocturia 2 or more times a night in pathophysiological groups based on selected lower urinary tract symptoms, clinical examination, frequency volume charts and urodynamics, and categorized the most likely pathophysiological causes of nocturia. MATERIALS AND METHODS: Participants were randomly selected among respondents in a population study of 4,000 individuals 60 to 80 years old living in Copenhagen County. Nocturia was assessed using the new and validated Nocturia, Nocturnal Enuresis, and Sleep-interruption Questionnaire. Nocturic (2 or more voids) or control (less than 1 void) status was assessed by a 3-day frequency volume chart. Participants were interviewed regarding lower urinary tract symptoms, and physical examination was performed. Nocturia pathophysiology was divided in 4 groups according to frequency volume chart variables, that is nocturnal polyuria, low bladder capacity, nocturnal polyuria and low bladder capacity in combination, and polyuria. Spontaneous flow rate and post-void residual urine were determined, and invasive urodynamic examination was performed in patients. RESULTS: Of 1,111 eligible individuals 75 patients and 75 controls were included. More patients vs controls had daytime frequency, urgency and urge incontinence. However, the difference was not significant in men. Nocturnal polyuria was the only pathophysiological finding that differed significantly in prevalence between patients and controls. The most prevalent urodynamic finding in patients was detrusor overactivity incontinence (26%) in women and detrusor overactivity (64%) in men. CONCLUSIONS: Urgency in women, and symptoms suggestive of bladder outlet obstruction in men were the major complaints. Frequency volume charts demonstrated that 55% of patients had nocturnal polyuria which was significantly more than controls. From frequency volume chart variables alone we could categorize 84% of the patients. When symptoms and urodynamic examination were added to the assessment, the most likely cause of nocturia was categorized in 96% of participants.     

Differences between nocturics and non-nocturics in voiding patterns: an analysis of frequency-volume charts from community-dwelling elderly

OBJECTIVE: To evaluate differences between elderly people with and without nocturia (waking up in the night to void) in terms of voiding habits, urine production and voided volumes. SUBJECTS AND METHODS: Nocturics or= two voids/night) and non-nocturics (< one void/night) were recruited from a questionnaire survey. Subjects were asked to complete a 3-day frequency-volume chart, including time and volume of each void, and their bedtime and waking time. Diaries from 108 non-nocturics and 116 nocturics were analysed. The number of voids, urine production, largest and average voided volumes were analysed using repeated-measures analysis of variance models, controlling for variables such as age, gender, body weight and gender-diagnosis interaction. RESULTS: Nocturnal urine volume was higher in nocturics than in non-nocturics. The difference between the groups was larger among the men (estimated difference 384 mL) than among the women (227 mL), but highly statistically significant (P < 0.001) in both genders. Among the men the diurnal urine and 24-h urine volumes were significantly higher in nocturics (difference, diurnal 131 mL, 24-h 462 mL, both P < 0.001). In the women the diurnal urine volume was lower in nocturics than in non-nocturics (difference 147 mL P = 0.0022) with no difference detected in 24-h urine volume. The largest voided volume was significantly less in nocturics than in non-nocturics; the difference was larger in women (128 mL, P < 0.001) than in men (42 mL, P = 0.0027). The average voided volume was 85 mL less (P < 0.001) in nocturics. The overlap between the groups in nocturnal urine and voided volumes was substantial and several significant covariates identified. The ratio between nocturnal urine volume and largest voided volume was the most statistically significant predictor of the number of nocturnal voids. CONCLUSION: Elderly nocturics had a higher nocturnal urine production and lower volume per void than non-nocturics. Differences between nocturics and non-nocturics in urine production and largest voided volume did not follow the same pattern in men and women. Nocturia was a result of a mismatch between nocturnal urine volume and largest voided volume, rather than abnormal values in either. The treatment of nocturia should be directed at one or both of these factors, depending on the findings from the 3-day frequency-volume chart of the individual.     

The evaluation and treatment of nocturia: a consensus statement

What’s known on the subject? and What does the study add? Nocturia is currently defined by the International Continence Society (ICS) as the complaint that an individual has to wake at night one or more times to void. It is, however, an underreported, understudied, and infrequently recognized problem in adults. Many factors may contribute to nocturia which are treatable, yet patients do not seek care or the condition may not be identified by providers. This paper aims to help healthcare providers better serve patients who are experiencing nocturia by summarizing current research, clinical approaches, and treatment options. The results of the conference provide a balanced evaluation of the full treatment armamentarium capable of meeting the needs of patients with the manifold causes of nocturia such as nocturnal polyuria, overactive bladder, or benign prostatic hyperplasia.