Nocturia in older men |
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Authors: | van Doorn Boris Bosch J L H Ruud |
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Affiliation: | Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. b.vandoorn@umcutrecht.nl |
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Abstract: | Nocturia is a common and bothersome symptom that impacts on sleep-quality and quality of life. Nocturia often has a multi-factorial etiology which makes thorough assessment of the complaint indispensable. This review summarizes the definition of nocturia, its epidemiology, clinical presentation, pathophysiology, diagnostics, and treatment options with special reference to older men. Nocturia is defined as a nocturnal voiding frequency of two or more, based on impact on quality of life. It is very prevalent in older men. Apart from the negative effects of sleep-disruption, it may be a risk-factor for hip fractures and increased mortality. Most common causes are: nocturnal polyuria, 24-h polyuria, overactive bladder (sometimes due to BPH) and sleep disturbance. A clear understanding of the etiology in the individual patient is indispensable when addressing the various possible causes and co-morbidities. Most important tool for this is the frequency-volume chart, but also patient history, physical examination and serum analysis. For treatment, lifestyle adjustments are often helpful. Medical therapy with 5-alpha reductase inhibitors, alpha-blockers, a combination of the two, or anti-muscarinics, has a limited effect. Most important medical option is desmopressin (arginine vasopressin analogue); however, treatment with this drug is limited to men under 65 years mainly due to the risk of hyponatraemia. |
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Keywords: | 5-ARI, 5-alpha reductase inhibitor 15D HRQoL, 15 dimension health related quality of life AUA-SS, American Urological Association symptom score BPH, benign prostatic hyperplasia DI, diabetes insipidus DOX, doxazosin FIN, finasteride FVC, frequency–volume chart HR, hazard ratio ICS, International Continence Society IPSS, international prostate symptom score LUTS, lower urinary tract symptoms NP, nocturnal polyuria NVF, nocturnal voiding frequency OAB, overactive bladder OSA, obstructive sleep apnea QoL, quality of life REM, rapid eye movement TER, terazosin TURP, transurethral resection of the prostate |
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