Loxoprofen sodium treatment for elderly men with refractory nocturia: Effect on night-time urine production

Abstract:   We evaluated the efficacy of loxoprofen sodium for refractory nocturia. Twelve men (mean age, 75.1 ± 5.7) with nocturia were enrolled in this study. All patients received 60 mg loxoprofen sodium prior to sleeping at night for 14 days. Nine of 12 patients (75%) felt more satisfaction than previous treatments. Patients were grouped into a loxoprofen sodium-effective ( n  = 7) and ineffective groups ( n  = 5) based on the results of the frequency-volume chart. In the effective group, interestingly, night-time urine volume showed significant reduction ( P  < 0.05). On the other hand, the average single voided volume at night and 24-h urine volume showed no significant change. There was a statistically significant difference in the night-time urine volume after treatment between groups ( P  < 0.01). Loxoprofen sodium is an effective treatment for some patients with refractory nocturia. The main effect mechanism of loxoprofen sodium may involve the reduction of night-time urine production.     

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.     

Efficacy of intranasal desmopressin in the treatment of nocturia due to nocturnal polyuria

Older adults often cite nocturia as one of the most bothersome lower urinary tract symptoms (LUTS). We investigated the efficacy and safety of intranasal desmopressin in the treatment of nocturia due to nocturnal polyuria on 12 patients (ten men, two women) ranging in age from 53 to 77 years (mean 67 years). All patients experienced more than two episodes of nocturia per night, and had a nocturnal urine volume greater than 35% of the daily voided volume, measured using a 3-day voiding diary with a frequency-volume chart. They began taking intranasal desmopressin (10 microg) at bedtime. When compared with the baseline data, the nocturnal urine volume, (928 +/- 307 versus 469 +/- 251 ml, p = 0.0007) and nocturnal frequency (4.8 +/- 2.0 versus 2.8 +/- 1.8, p = 0.0009) were significantly decreased. The daytime urine volume (1,008 +/- 458 versus 930 +/- 419 ml, p = 0.49) did not change significantly. The unine osmolarity (420 +/- 143 versus 598 +/- 158 mOsm/kg, p = 0.0065), and urine sodium levels (100 +/- 32 versus 140 +/- 60 mEq/l, p = 0.007) increased significantly, whereas the serum sodium levels (141 +/- 3 versus 135 +/- 7 mEq/l, p = 0.048) decreased significantly. Among the 12 patients, 5 (41.6%) patients reported side effects, including headache in 1, edema in 1 and hyponatremia in 3. The patient with edema discontinued medication, but the other 4 patients continued their medication and the side effects subsided. In conclusion, desmopressin is an effective treatment for adult patients complaining of nocturia due to nocturnal polyuria. One should be aware of the potential side effects including hyponatremia.     

Analysis of nocturia with 24‐h urine volume,nocturnal urine volume,nocturnal bladder capacity and length of sleep duration: concept for effective treatment modality

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Main causes of nocturia are 24‐hour polyuria, nocturnal polyuria, decreased bladder capacity and sleep disorder. This study revealed that nocturia is closely related to four factors, namely, 24‐hour urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration and evaluation of all these factors through analysis of bladder diaries is clinically important to decide which is the main contributing factor in patients with nocturia and to determine suitable treatment modality on an individual basis.

OBJECTIVE

? To determine the relationship between the number of nocturia and 24‐h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration as well as to assess the significance of these factors with respect to eliminating nocturnal voidings in individual patients with nocturia.

PATIENTS AND METHODS

? Among 532 participants who completed a 3‐day bladder diary between April 2005 and December 2006, the diaries of 450 participants without 24‐h polyuria were analyzed. ? Clinical variables such as the number of daytime and night‐time voids, 24‐h urine volume, nocturnal polyuria index, daytime and night‐time maximum voided volumes (MVV), night/day MVV ratio, sleep duration and proportion of night/day urine production rates were obtained from each diary. ? Participants were classified into eight groups according to values of three factors: nocturnal MVV, proportion of night/day urine production rates and length of sleep duration. ? Each group was divided into three subgroups: non‐nocturics (number of nocturnal voidings is zero), mild nocturics (number of nocturnal voidings is one) and severe nocturics (number of nocturnal voidings is two or more). ? The data from non‐nocturics with three normal factors were regarded as the normal control and compared with the variables of the other subgroups using Dunnett’s method.

RESULTS

? Variables that form the basis of classifying participants into eight groups and corresponding to abnormal factors of each group were statistically significant in all the subgroups of each group. ? Furthermore, a significantly increased 24‐h urine volume was found in severe nocturics of the group with three normal factors. ? A significantly decreased 24‐h urine volume was found in non‐nocturics of groups with nocturnal polyuria, decreased bladder capacity and both long sleep duration and nocturnal polyuria. ? A significantly increased nocturnal MVV and night/day MVV ratio were shown in non‐nocturics and mild nocturics of the groups with nocturnal polyuria and both long sleep duration and nocturnal polyuria.

CONCLUSIONS

? Because nocturia is a multifactorial disorder and closely related to four factors (i.e. 24‐h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration), the evaluation of all these factors appears to be clinically useful for determining the main contributing factor in patients with nocturia as well as the suitable treatment modality on an individual basis. ? Physicians should take all these factors into consideration in the evaluation and treatment of nocturia.     

Clinical guidelines for nocturia

Nocturia is a bothersome condition, defined as a complaint whereby the individual has to wake one or more times per night in order to void. Nocturia that occurs twice or more per night can have a substantial adverse effect on the patient's quality of life (QOL), and in many cases treatment may be required. These guidelines provide a treatment algorithm for use by primary care physicians. The initial assessment is conducted through a history taking interview. With a clear understanding of symptoms, patients can be classified into three broad categories: (1) nocturia only, (2) nocturia and diurnal pollakisuria without other lower urinary tract symptoms, and (3) nocturia and diurnal pollakisuria accompanying other lower urinary tract symptoms. For treatment, the literature supporting each form of drug therapy was ranked and a recommendation grade was determined for each form of therapy. A grade of ‘F (pending)’ was applied to any drug not currently approved for use in Japan or for which the efficacy and safety in Japanese patients was unconfirmed at the time of evaluation. We recommend instruction and guidance on water intake that will generally result in 24‐h urine volume of 20 to 25 mL/kg. This corresponds to a daily water intake of 2.0% to 2.5% of body weight. In Japan, desmopressin is indicated for central diabetes insipidus and nocturnal enuresis, but not indicated for nocturia. The therapeutic mechanism of the anticholinergic drugs for nocturia may depend on the action of the sensory nerve mediated by the muscarinic receptors.     

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.     

Sleep duration is an independent factor in nocturia: analysis of bladder diaries

OBJECTIVE

To analyse the relationship between the number of nocturia episodes and other variables obtained from a bladder diary, with special attention to the duration of sleep, as nocturia is closely related to sleep disorders.

PATIENTS, SUBJECTS AND METHODS

Between April 2005 and December 2006, 532 participants, including both community‐dwelling subjects who underwent a mass screening programme and outpatients who consulted the department of urology, completed a 3‐day bladder diary. Clinical variables, i.e. the number of daytime and night‐time voids, diurnal and nocturnal urine volume, daytime and night‐time maximum voided volume, sleep duration and nocturnal polyuria index (NPi) were obtained from the diary. The variables were assessed by univariate analysis in all participants, and by multiple regression analysis of all participants, males, females, subjects in mass screening and those with no 24‐h polyuria, to determine which variables were independently associated with the number of nocturia episodes.

RESULTS

Univariate analysis showed a considerable correlation between the nocturia episodes and age, nocturnal urine volume, NPi and sleep duration. On multiple regression analysis, age, nocturnal urine volume, night‐time maximum voided volume and sleep duration were independently related to number of nocturia episodes in all subgroups.

CONCLUSIONS

Sleep duration was confirmed as an independent factor in nocturia. Sleep conditions, including sleep duration, should be considered when evaluating and treating patients with nocturia.     

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.     

Interstitial cystitis: Clinical manifestations and diagnostic criteria in over 200 cases

Over 200 patients were evaluated for the syndrome of interstitial cystitis. The average patient was found to void 16 times per day with an average volume of 106 ml, nocturia averaged 4–6 times (but 18% of patients voided < 2 times per night) and symptoms were present at least 1 year. Eight-five percent of the patients were female and 83% had pain. The median age was 44. Cystoscopic changes revealed no carcinoma or carcinoma in situ in 175 patients studied with an average capacity under anesthesia of 561 ml (measured in 175 patients). Only 8% of the patients had ulcers and 89% had glomerulations. Seventy-five patients had cystometrograms demonstrating an average maximum capacity of 220 ml and an increased sensory urgency in 95% of patients (< 100 ml volume stimulating urgency was considered abnormal). The 90% confidence limit for findings in this disease showed the average voids per day was at least 10, with an average voided volume of < 160 ml, nocturia at least 1–2 per night, duration of symptoms over 1 year, anesthetic bladder capacity of < 850 ml.     

Nocturia and circadian blood pressure profile in healthy elderly male volunteers

PURPOSE: Nocturia is attributed to nocturnal polyuria and/or decreased functional bladder capacity. In this study we elucidated the mechanisms behind circadian fluid regulation and the occurrence of nocturia in healthy elderly males, specifically to determine the role of urine output and regulating hormones, blood pressure, and average voided volumes. MATERIALS AND METHODS: A total of 18 males 55 to 73 years old (mean age 61.1) were included in the study. Voiding habits were assessed by completion of a 7-day frequency volume chart recording all fluid intake and voiding. The subjects subsequently underwent inpatient circadian studies measuring the diurnal rhythm of blood pressure, vasopressin, atrial natriuretic peptide, angiotensin II, aldosterone and urine volume. RESULTS: Of the nightly home recordings 25% showed nocturia, characterized by a higher 24-hour and nighttime urine volume. During the inpatient studies 12 of the 18 participants experienced a nocturnal void. Nocturia nights were characterized by significantly decreased day-to-night ratios in urine output and a higher nighttime mean arterial blood pressure. A circadian variation in plasma arginine vasopressin was seen only in the group without nocturia. The other hormones revealed a circadian rhythm similar in the 2 groups. CONCLUSIONS: In healthy males with occasional nocturia, the occurrence of nocturia seems to be associated with a blunting of the circadian rhythm of diuresis and increased arterial blood pressures during the night. These findings may implicate a role for a baroregulatory related mechanism in 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.     

Nocturia treatment outcomes: Analysis of contributory frequency volume chart parameters

Aims

Our aim is to determine which changes in frequency volume chart (FVC) parameters are associated with nocturia improvement.

Methods

This is a real life retrospective analysis of FVC's of men who were treated for nocturia and completed at least two 24 h FVC's. Patients were divided into two groups—an improved cohort defined by a decrease of ≥1 nocturnal void from baseline and a non‐improved cohort.

Results

A total of 414 FVC's were analyzed (207 baseline and 207 post treatment) among a cohort of 105 men. Baseline nocturia severity (ANV, 3.5 vs. 2.3, respectively) and nocturnal urine volume (NUV, 880 mL vs. 650 mL) was greater in the improved cohort compared to the non‐improved cohort. The improved cohort had a decreased 24 h volume (?310 vs. +120 mL), and NUV (?290 vs. +170 mL) compared to the non‐improved cohort. At the followup visit, the improved cohort experienced a statistically significant decline in ANV (?1.8 vs. +1.0). No significant difference was seen in baseline 24 h volume or bladder capacity (MVV), though patients in the improved cohort experienced a small decrease in MVV. First uninterrupted sleep period (FUSP) increased significantly in the improved cohort (+1.8 h), and dropped (?0.6 h) in the non‐improved cohort.

Conclusions

Improvement in nocturia was associated with a decrease in both 24 h voided volume and NUV, but not MVV, suggesting that improved patients consumed less fluid. The increase in FUSP in the improved cohort demonstrates the potential for nocturia therapies to improve impaired sleep architecture.     

Association with relative nocturnal polyuria using BNP (brain natriuretic peptide) in eldely patients with nocturia

OBJECTIVE: In addition to overactive bladder (OAB) and sleep disorders (disturbance of additional sleep induction), nocturnal polyuria has been reported as an etiology of nocturia in elderly people. To investigate the influence of heart function on nocturnal polyuria in elderly people, we examined the association with nocturnal polyuria using brain natoriuretic peptide (BNP), which are useful for evaluating the prognosis of heart failure. PATIENTS AND METHODS: The patients were 128 patients (92 males, 36 females) who were treated for nocturia in Kohsei general hospital and other relative hospital between October 2002 and September 2005. We measured BNP levels at physical examination. Simultaneously, the patients were instructed to write a frequency volume chart (FVC) for 4 days. 24-hour urine volume, Daytime urine volume, nocturnal (sleep) urine volume, nocturnal polyuria index (NPi) were calculated from FVC. The association was examined. However, alphal-blockers or anticholinergic agents that had been prescribed to treat urination disorders were continuously administered. RESULTS: Overall, the mean BNP level was high, 46.3+/-39.6 pg/ml. The mean 24-hour urine volume was 1,555+/- 458 ml. The mean daytime urine volume was 935+/-322 ml. The mean nocturnal urine volume was 624+/-251 ml. The mean nocturnal urine volume rate was high, 40.1 - 10.5%. However, there was a close association between BNP and the 24-hour urine volume (p = 0.0215), the daytime urine volume (p = 0.0004), the NPi (p = 0.0003). The daytime urine volume decreased with the BNP level. The NPi increased with the BNP level. Patients were divided into 2 groups, a group with a BNP level less than 50 pg/ml and a group with a BNP level of 50 pg/ml or more. In the group with a BNP level less than 50 pg/ml, the nocturnal urine volume rate was 38.14+/-10.07%. In the group with a BNP level of 50 pg/ml or more, the rate was significantly higher (43.97+/-10.48%, p<0.0029). CONCLUSIONS: These results suggest that many elderly patients latently have mild heart failure, and that relative nocturnal polyuria reduces cardiac load. Therefore, in patients with a high BNP level, administration of antidiuretic hormone to decrease nocturnal urine volume is risky. Administration of diuretics during the afternoon or evening may be safer.     

Nocturia and complementary indices: determination and quantification of the cause of nocturia by frequency-volume charts in women with lower urinary tract symptoms

We evaluated differences between women with lower urinary tract symptoms (LUTS) with and without nocturia in terms of voiding habits, urine production and voided volumes in order to determine and quantify the cause of nocturia by using frequency-volume (FV) charts. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score assessment, received a thorough explanation from the study coordinators, and were requested to complete a 3-day FV chart. Of the 123 women enrolled, 106 (86.2%) 20–83 years old (median age 55.0) completed the study. Nocturnal urine volume was higher in nocturics than in non-nocturics, but this was not statistically significant. Total daytime voided volume was lower in nocturics than in non-nocturics (P=0.030) but with no detectable difference in total voided volume. To identify possible risk factors, we examined age and night time parameters including the nocturnal bladder capacity index (NBCI), nocturnal polyuria index (NPI) and nocturia index (NI) by univariate logistic analysis. When nocturia was defined as voiding at least twice per night, age and NI were found to be associated with it by univariate analysis. These two variables were further analyzed using a multivariate logistic model to determine their association with nocturia. In the multivariate analysis, a positive association was observed between age and nocturia. Patients 50 years or older had a 3.9-fold higher risk [odds ratio (OR) 3.86; 95% confidence interval (CI) 1.60–9.31; P=0.003] of voiding at least twice per night than those younger than 50 years. In the same model, patients with NI greater than 1.5 had a 4.5-fold higher risk of voiding at least twice per night (OR 4.59; 95% CI 1.80–11.17; P=0.001). FV charts are valuable for determining the cause of nocturia in women with LUTS. Our findings suggest that age and the NI may be important variables in the evaluation of nocturia in women with LUTS.     

Classification and distribution of symptomatic nocturia with special attention to duration of time in bed: a patient-based study

OBJECTIVE: To classify the night-time urinary frequency of patients with symptomatic nocturia by urine volume produced, nocturnal bladder capacity and time spent in bed. PATIENTS, SUBJECTS AND METHODS: In all, 110 patients whose principal complaint was nocturia were enrolled in the study; 32 age- and gender-matched subjects were recruited as controls. From studies of the controls, 190 mL and 510 min were identified as the normal limits for mean nocturnal urine voided volume and time spent in bed. The 110 patients were classified into eight categories based on urine volume, nocturnal bladder capacity and time spent in bed. RESULTS: There were abnormalities of urine volume produced, bladder capacity and time spent in bed in 72%, 50% and 54% of the patients, respectively. Patients with severe nocturia (> or =4 voids/night) tended to have more complex pathophysiology than those with mild nocturia (< or =3 voids/night). CONCLUSION: Time spent in bed, urine volume produced and bladder capacity should be used to assess patients with symptomatic nocturia.     

Nocturia in adults: Etiology and classification

Nocturia is one of the most bothersome of all urologic symptoms, yet even a rudimentary classification does not exist. We herein propose a classification system of nocturia based on a retrospective study. The records of 200 consecutive patients with nocturia were reviewed. Evaluation included history, micturition diary (including day, night, and 24-hr voided volume), postvoid residual urine (PVR), and videourodynamic study (VUDS). Functional bladder capacity (FBC) was determined to be the largest voided volume in a 24-hr period. The etiology of nocturia was thus classified into one of three groups: nocturnal polyuria ([NP] in which voided urine volume during the hours of sleep exceeds 35% of the 24-hr output), nocturnal detrusor overactivity ([NDO] defined as nocturia attributable to diminished bladder capacity during the hours of sleep), and mixed (NP + NDO); polyuria (24-hr urine output >2,500 cc) was classified separately. There were 129 women and 65 men ranging in age from 17 to 94 years (x = 59). Overall 13 (7%) had NP, 111 (57%) NDO, and 70 (36%) had a mixed etiology of their nocturia (both NP and NDO). Forty-five (23%) also had polyuria. These data confirm that the etiology of nocturia is multifactorial and in many instances unrelated to the underlying urologic condition. Nocturnal overproduction of urine is a significant component of nocturia in 43% of patients, most of whom will also have NDO. We believe that treatment should be directed at both conditions. Neurourol. Urodynam. 17:467–472, 1998. © 1998 Wiley-Liss, Inc.     

Biochemical and body composition analysis of nocturia in the elderly

AIMS: Nocturia is a common symptom in the elderly, and various contributing factors have been suggested. Therefore, in order to investigate which factors are strongly related to occurrence of nocturia, we performed a suite of examinations. METHODS: One hundred eighty volunteers were divided into three groups: a young adult control group (60 healthy persons without nocturia), an elderly control group (60 healthy persons with a low mean frequency of nocturnal urination, i.e., twice per night) in the elderly.     

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.     

Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women

The objective of this study was to estimate the prevalence of nocturia in incontinent women in a urogynaecologic practice and its association with the quality of life and to estimate the prevalences of the pathophysiological categories among nocturics. From 1 January 2002, all patients with complaints of urinary incontinence were analysed according to a specific protocol: multichannel urodynamic testing, a 1-h International Incontinence Society (ICS) pad test and a 3-day frequency-volume (FV) chart. From 1 June 2002, subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. Evaluable FV charts were received from111 patients, and 72 patients completed the questionnaires correctly. The overall prevalence of nocturia was 48.6% (confidence interval: 43.9–53.3%). Nocturia had a negative impact on several aspects of the quality of life. The maximum voided volume was significantly (p=0.005) less in nocturics. The 24-h frequency was higher in nocturics (p=0.001). Nocturics lost more urine during the pad test (p=0.039). The multivariate logistic regression analysis showed that the greater the proportion of 24-h urine excreted at night, the greater the odds of having nocturia and that the lesser the maximum voided volume, the greater the odds of having nocturia. The majority (92.7%) of the nocturics can be classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 51.2%, a low functional bladder capacity in 14.6%, a combination of both in 9.8%, polyuria in 4.9% and a combination of polyuria and nocturnal polyuria in 12.2% of the cases. Nocturia is a frequent symptom among urinary incontinent patients, with a negative impact on several aspects of the quality of life. With a FV chart, nocturics can be classified into one of the responsible pathophysiologic categories in the majority (92.7%) of the cases.This study was supported with an independent grant from Ferring Pharmaceuticals, The Netherlands