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Iinuma K, Nishino Y, Matsuoka K, Ihara T, Makabe S, Tanji R, Harigane Y, Ishida K, Tamaki M, Yokoi S, Hoshino H, Yuhara K, Yamada T, Kubota Y, Miwa K, Kikuchi M, Kojima Y, Mitsui T, Koie T. The prevalence and predictive factors of nocturnal polyuria in Japanese patients with nocturia: a multicentral retrospective cohort study. Sci Rep 2023; 13:18128. [PMID: 37875562 PMCID: PMC10597993 DOI: 10.1038/s41598-023-45311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023] Open
Abstract
The aims of this study were to determine the prevalence and predictors of nocturnal polyuria (NP) in Japanese patients. This multicentral, observational study enrolled patients with the chief complaint of nocturia at 17 Japanese institutions between January 2018 and December 2022. The frequency of daily voiding and volume of urination were evaluated using bladder diaries. NP was diagnosed in patients with an NP index of > 33%. The primary endpoint was NP prevalence in patients with nocturia. The secondary endpoints were the prevalence of NP according to sex and age and the identification of factors predicting NP. This study analyzed 875 eligible patients. NP was present in 590 (67.4%) patients, with prevalence rates of 66.6% and 70.0% in men and women, respectively. Age ≥ 78 years, body mass index (BMI) < 23.0 kg/m2, and patients with ischemic heart or cerebrovascular disease were significant predictors of NP (P < 0.001, P < 0.001, P = 0.014, P = 0.016, respectively). This is the first large multicenter study to investigate the prevalence of NP in Japanese patients with nocturia. NP has a prevalence of 67.4%. Significant predictors of NP include age, BMI, and cardiovascular disease.
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Affiliation(s)
- Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | | | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University, 1 Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan
| | - Tatsuya Ihara
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, 1110 Shimokato, Chuo, Yamanashi, 408-3898, Japan
| | - Shunta Makabe
- Department of Urology, Ohara General Hospital, 6-1 Uwamachi, Fukushima, Fukushima, 960-8611, Japan
| | - Ryo Tanji
- Department of Urology, Japanese Red Cross Fukushima Hospital, 7-7 Yashimacho, Fukushima, Fukushima, 960-8530, Japan
| | - Yuki Harigane
- Department of Urology, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Kenichiro Ishida
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu, Gifu, 500-8717, Japan
| | - Masayoshi Tamaki
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashimacho, Gifu, Gifu, 500-8513, Japan
| | - Shigeaki Yokoi
- Department of Urology, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 5058510, Japan
| | - Hiroki Hoshino
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu, 503-8502, Japan
| | - Kazuya Yuhara
- Department of Urology, Japanese Red Cross Takayama Hospital, 3-11 Tenmancho, Takayama, Gifu, 506-8550, Japan
| | - Toru Yamada
- Department of Urology, Tokai Central Hospital, 4-6-2 Soharahigashijimacho, Kagamihara, Gifu, 504-8601, Japan
| | - Yasuaki Kubota
- Department of Urology, Toyota Memorial Hospital, 1-1 Heiwamachi, Toyota, Aichi, 471-0821, Japan
| | - Kousei Miwa
- Department of Urology, Japanese Red Cross Gifu Hospital, 3-36 Iwakuracho, Gifu, Gifu, 502-8511, Japan
| | - Mina Kikuchi
- Sugo Clinic, 1-10-16 Sugo, Gifu, Gifu, 502-0914, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University, 1 Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, 1110 Shimokato, Chuo, Yamanashi, 408-3898, Japan
| | - Takuya Koie
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
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Ma K, Dong Q. Association between sleep quality and benign prostate hyperplasia among middle-aged and older men in India. BMC Public Health 2023; 23:1147. [PMID: 37316942 DOI: 10.1186/s12889-023-15972-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The association between sleep quality and benign prostate hyperplasia (BPH) has rarely been studied. The aim of this study was to examine the relationship between sleep quality and BPH among middle-aged and older men in India. METHODS This study used data from men over 45 years old in Wave 1 (2017-2018) of the Longitudinal Aging Study in India (LASI). Benign prostate hyperplasia was self-reported, and sleep symptoms were assessed using five questions modified from the Jenkins Sleep Scale. A total of 30,909 male participants were finally included. Multivariate logistic regression analysis, subgroup analysis, and interaction tests were performed. RESULTS Total 453 (1.49%) men reported benign prostatic hyperplasia and have higher sleep quality score (9.25 ± 3.89 vs. 8.13 ± 3.46). The results revealed that the sleep quality score and risk of benign prostatic hyperplasia were significantly correlated after adjusting for all confounding factors (OR:1.057, 95% CI: 1.031-1.084, p < 0.001]. After dividing people into four groups based on the quartile of sleep quality scores, compared with the first quartile group, the third quartile group was 1.32 times, and the fourth quartile group was 1.615 times more likely to develop benign prostate hyperplasia. A significant interaction effect of alcohol consumption was observed. (p for interaction < 0.05). CONCLUSION Worse sleep quality was significantly associated with a higher incidence of benign prostatic hyperplasia among middle-aged and older Indian men. A further prospective study is needed to clarify this association and explore potential mechanisms.
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Affiliation(s)
- Kai Ma
- Department of Urology, institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Qiang Dong
- Department of Urology, institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China.
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Bozkurt O, Irer B, Kizilay F, Erbatu O, Sen V, Cinar O, Ongun S, Cihan A, Ozdemir T, Tasdemir D, Ucer O. Mechanisms and grading of nocturia: Results from a multicentre prospective study. Int J Clin Pract 2021; 75:e13722. [PMID: 32969572 DOI: 10.1111/ijcp.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. METHODOLOGY After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, and P < .05 was deemed as statistically significant. RESULTS About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. CONCLUSIONS Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.
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Affiliation(s)
- Ozan Bozkurt
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Fuat Kizilay
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - Oguzcan Erbatu
- Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Volkan Sen
- Department of Urology, Manisa City Hospital, Manisa, Turkey
| | - Onder Cinar
- Department of Urology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Sakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Ahmet Cihan
- Department of Urology, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
| | - Turan Ozdemir
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - Dogu Tasdemir
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Oktay Ucer
- Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey
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Nocturia is Associated with High Atherosclerotic Cardiovascular Disease Risk in Women: Results from the National Health and Nutrition Examination Survey. J Community Health 2021; 46:854-860. [PMID: 33495885 DOI: 10.1007/s10900-021-00962-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
Growing evidence has identified nocturia as a potential manifestation of several cardiovascular disease states. We aimed to determine whether a relationship exists between nocturia and global atherosclerotic cardiovascular disease (ASCVD) risk, defined by the American College of Cardiology/American Heart Association (ACC/AHA) ASCVD risk calculator, using a large nationally-representative study sample from the United States. We explored potential associations between nocturia and ASCVD risk in adults aged 40-79 years with no prior history of overt/known atherosclerotic disease from 7 consecutive cycles of the National Health and Nutrition Examination Survey. Subjects were classified by whether they met the ASCVD high-risk threshold following current ACC/AHA consensus guidelines (10-year major adverse cardiovascular event risk ≥ 20%). Logistic regression analyses were used to explore associations between nocturia (defined as ≥ 2 nocturnal voids) and ASCVD risk. The prevalence of nocturia and high ASCVD risk were 27.0% and 10.9%, respectively. Nocturia, older age, increased body mass index, and diuretic use were associated with high ASCVD risk on univariate logistic regression. After adjusting for age, body mass index, and diuretic use, nocturia remained associated with significantly greater odds of high ASCVD risk in females but not in males. Elicitation of nocturia on clinical history taking may serve to identify high cardiovascular risk in females. Future studies are needed to elucidate mechanisms underlying this association.
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Nocturnal Urine Production in Women With Global Polyuria. Int Neurourol J 2020; 24:270-277. [PMID: 33017897 PMCID: PMC7538286 DOI: 10.5213/inj.2040166.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/18/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Low nocturnal urine production (NUP) may be sufficient to rule out global polyuria (GP) in men. This study determines the sensitivity of indices for nocturnal polyuria (NP), defined as nocturnal polyuria index (NPi; nocturnal urine volume/24-hour urine volume) ≥0.33 or NUP ≥90 mL/hr, for detecting GP in women. METHODS Data were analyzed from 2 prospective protocols involving subjects recruited from a urology ambulatory care unit and a continence clinic. Women ≥18 years with nocturia were included if they met either of 2 common criteria for GP: (1) ≥40 mL/kg/24 hr or (2) ≥3,000 mL/24 hr. RESULTS Thirty-one women were included (NPi, 28.6 [21.3-40.7]; NUP, 100.8 [68.3-135.8] mL/hr). At the ≥40 mL/kg/24-hr cutoff, 40% and 63% of women reporting ≥1 nocturnal void(s) (n=30) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. Additionally, 53% and 71% of subjects reporting ≥2 nocturnal voids (n=17) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. At the ≥3,000 mL/24-hr cutoff, 38% and 69% of women reporting ≥1 nocturnal void(s) (n=13) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively, and 63% and 88% of subjects reporting ≥2 nocturnal voids (n=8) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. By extension, 37%-62% of women with nocturia and GP did not have NP by NPi ≥0.33 criteria, and 12%-37% did not have NP by NUP ≥90 mL/hr criteria. CONCLUSION Indices of excess nighttime urination do not reliably predict GP in women. A full-length voiding diary may be particularly important in the evaluation of women with nocturia. Nocturia in women merits further consideration as a distinct entity.
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Tanner L, Thomson K, Drake MJ, Ervin CF, Bower WF, Pearson F. Behavioural interventions for nocturia in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Katie Thomson
- Evidence Synthesis Group, Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Marcus J Drake
- School of Clinical Sciences; University of Bristol; Bristol UK
| | - Claire F Ervin
- Department of Medicine and Aged Care; The Royal Melbourne Hospital; Parkville Australia
| | - Wendy F Bower
- Department of Medicine and Aged Care; The Royal Melbourne Hospital; Parkville Australia
| | - Fiona Pearson
- Evidence Synthesis Group, Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
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Monaghan TF, Bliwise DL, Dmochowski RR, Lazar JM, Birder LA, Everaert K, Weiss JP. Associations between nighttime and daytime maximum voided volumes: Relevance for nocturia? Neurourol Urodyn 2020; 39:2301-2304. [PMID: 32809270 DOI: 10.1002/nau.24485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022]
Abstract
AIM The relationship between maximum voided volumes (MVV) during the night and day is poorly understood. Such measurements are important because they are often used to indicate functional bladder capacity (FBC), a relevant parameter for nocturia. This study examined the association of such nighttime and daytime measurements in men with nocturia. METHODS We retrospectively analyzed 356 24-hour voiding diaries showing ≥2 nocturnal voids from 220 men at an outpatient urology clinic. We defined small FBC as MVV ≤ 200 mL. RESULTS A total of 131 entries demonstrated a nocturnal MVV ≤ 200 mL, of which a majority (98 [74.8%]) also showed a 24-hour MVV ≤ 200 mL (ie, global small FBC), and 33 (25.2%) exceeded the 200 mL threshold during the day (ie, nocturnal-specific small FBC). Correspondingly, among voiding diaries without global small FBC (n = 258), most (225/258 [87.2%]) showed a nocturnal MVV > 200 mL. Data were similar when analyzing only the first complete voiding diary per case, when limiting analyses to those without benign prostatic obstruction, and when limiting analyses to cases with nocturnal polyuria. CONCLUSION Nocturia may be attributable to nocturnal-specific small FBC or global small FBC. Although the etiology of nocturnal-specific small FBC remains unclear, it was present in a significant minority of patients with small FBC, thus necessitating more directed research. Conversely, diminished nocturnal MVV was nevertheless relatively uncommon in the absence of global small FBC, such that nocturnal-only voiding diaries may provide a rational alternative for follow-up evaluation in patients with nocturia due to global small bladder capacity.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason M Lazar
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Lori A Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
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Abstract
PURPOSE OF REVIEW Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of nocturia is multifactorial and management remains a challenge. Herein, we provide an overview of the management strategies for nocturia and summarize the existing evidence for treatment of nocturia across the condition's broad etiologic categories: nocturnal polyuria, diminished bladder capacity, and global polyuria. RECENT FINDINGS Treatment should begin with behavioral modification. A high level of evidence supports the efficacy of desmopressin in the treatment of nocturnal polyuria. Data supporting the efficacy of α-blockers, antimuscarinics, and surgical bladder outlet procedures in the treatment of nocturia remains limited. Treatment options for nocturia are determined by underlying mechanism. Desmopressin is effective in treating nocturnal polyuria. Surgical intervention, α-blockers, and antimuscarinics may improve nocturia when associated with lower urinary tract symptoms or overactive bladder in the setting of diminished bladder capacity.
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Affiliation(s)
- Danielle J Gordon
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.
| | - Curran J Emeruwa
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA
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Weiss JP, Everaert K. Management of Nocturia and Nocturnal Polyuria. Urology 2019; 133S:24-33. [DOI: 10.1016/j.urology.2019.09.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 01/15/2023]
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Li ESW, Flores VX, Weiss JP. Current guidelines and treatment paradigms for nocturnal polyuria: A "NEW" disease state for US physicians, patients and payers. Int J Clin Pract 2019; 73:e13337. [PMID: 30810265 DOI: 10.1111/ijcp.13337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023] Open
Abstract
Nocturia is one of the most bothersome symptoms encountered in urology, and its prevalence rises with age. Causes include both urological and non-urological aetiologies, often in combination. The effects of nocturia on a patient's quality of life can be detrimental. The initial approach to managing this condition includes appropriately classifying nocturia based on the results of a 24-hour bladder diary. Broadly, the categories under which nocturia can be classified include: low nocturnal or global bladder capacity, nocturnal polyuria, global polyuria and mixed.Based on the type of nocturia and possible underlying causes, clinicians can appropriately discuss with patients the treatment plans that may include a combination of behavioural, pharmacologic, and invasive therapy. The available literature on the management of nocturia was reviewed. Findings were incorporated into a practice-based approach for its workup and treatment.
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Affiliation(s)
- Eric S W Li
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Viktor X Flores
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
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Choi YS, Kim JC, Kim YH, Choi JB, Park WH, Lee DH. Classification of nocturia by analyzing frequency volume chart and relations with international prostate symptom score in male patients with lower urinary tract symptoms in Korea. Investig Clin Urol 2019; 60:267-274. [PMID: 31294136 PMCID: PMC6607079 DOI: 10.4111/icu.2019.60.4.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/25/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose To evaluate the categories of nocturia and relationships with the international prostate symptom score (IPSS) in Korean men with lower urinary tract symptoms (LUTS) accompanying nocturia. Materials and Methods Five hundred twenty-one male patients from five different hospitals, aged ≥18 years, were included. The 3-day frequency volume chart was used to identify nocturia. We also used the IPSS and The International Consultation on Incontinence Modular Questionnaire-Nocturia (ICIQ-N) module to verify the correlation between nocturia and quality of life. Results The distribution of nocturia events varied from 1 to 11, and 2 nocturia events were most prevalent (48.4%). Across the various numbers of nocturia events, the mean age, first sleep period, functional bladder capacity (FBC), nocturnal polyuria index (NPI), nocturia index (NI), predicted number of nightly voids, and nocturnal bladder capacity index (NBCI) were statistically different. Patients with pure nocturnal polyuria showed different night lengths, nocturnal urine volume, FBC, NPI, NI, and predicted number of nightly voids than those without nocturnal polyuria. Patients with severely reduced NBCI were prominent in the IPSS >20 group, and the degree of vexation increased with the number of nocturia events. The IPSS storage symptom score and ICIQ-N symptom score positively correlated with nocturia events. Conclusions In Korean male LUTS patients with nocturia, mixed-type nocturia was prominent, and patients with a high IPSS had a much poorer sleep quality than those with a low IPSS.
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Affiliation(s)
- Yong Sun Choi
- Department of Urology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Young Ho Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University, Bucheon, Korea
| | - Jong Bo Choi
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Won Hee Park
- Department of Urology, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Dong Hwan Lee
- Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Singer J, O'Connell KA. Relationship of cue-induced urinary urges to nocturia in women ages 18 to 40 years. Neurourol Urodyn 2019; 38:1378-1383. [PMID: 30939224 DOI: 10.1002/nau.23996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/16/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022]
Abstract
AIMS Although physiological factors have a role in nocturia, research suggests that behavioral processes, especially classical conditioning may also play an important role in nocturia and other lower urinary tract symptoms. The study aimed to assess the relationship of stimulus-associated urges during the day to nocturia in a sample of women aged 18 to 40, after controlling for physiological symptoms (eg, overactive bladder [OAB]; daytime frequency). METHODS An online study was conducted using a panel of 356 female participants between the ages of 18 to 40. One-third of the participants self-reported an OAB diagnosis as determined by their physician. Almost 80% of participants reported having at least one nocturnal voiding per night. Participants completed the Urinary Cues Questionnaire, which assessed the frequency with which respondents experienced the urge to urinate in the presence of a variety of cues and the Overactive Bladder Screening Scale (OABSS), which assesses symptoms of OAB syndrome. RESULTS Controlling for OABSS scores and daytime urinary frequency, the Situational Cues Subscale had a significant relationship with nocturia such that with each unit increase in the subscale, the probability of nocturia increased by 12% to 14% depending on the definition of nocturia. DISCUSSION Behavioral techniques, such as habituation to decrease the association between awakening at night and feeling an urge to urinate, may be an appropriate intervention to mitigate nocturnal urination. Theoretically, this would translate to decreasing this disorder throughout the lifespan, if behavioral techniques could be effectively utilized in early adulthood.
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Affiliation(s)
- Jonathan Singer
- Department of Clinical Psychology, University of Nevada, Reno, Nevada
| | - Kathleen A O'Connell
- Department of Health and Behavior Studies, Teachers College Columbia University, New York City, New York
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Taha DE, Aboumarzouk OM, Shokeir AA. Oral desmopressin in nocturia with benign prostatic hyperplasia: A systematic review of the literature. Arab J Urol 2018; 16:404-410. [PMID: 30534439 PMCID: PMC6277262 DOI: 10.1016/j.aju.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/15/2018] [Accepted: 06/13/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the effect of oral desmopressin in patients with nocturia associated with benign prostatic hyperplasia (BPH). Patients and methods With a rise of the use of oral desmopressin in the treatment of nocturia in patients with BPH, a systematic review was performed according to the Cochrane systematic reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Results The literature search yielded 18 studies. The studies were published between 1980 and 2017, and included 3072 patients. Eligible patients were men aged ≥50 years with lower urinary tract symptoms (LUTS) and persistent nocturia. There was a significant 43% reduction in nocturia after using desmopressin alone. Combined α-blockers and desmopressin lead to a decrease in the frequency of night voids by 64.3% compared to 44.6% when using α-blockers only. The first sleep period, significantly increased from 82.1 to 160.0 min and from 83.2 to 123.8 min when using desmopressin + α-blocker and α-blocker only, respectively. The desmopressin dose ranged from the lowest dose (0.05 mg) to the optimum dose (0.4 mg) at bed time. The incidence of hyponatraemia associated with desmopressin use was 4.4–5.7%. Conclusion Low-dose oral desmopressin therapy alone is an effective treatment for nocturia associated with LUTS in patients with BPH. Oral desmopressin combined with α-blockers is well tolerated and beneficial for improving the International Prostate Symptom Score and nocturnal symptoms. All patients should be educated about the mechanism of desmopressin action to avoid treatment discontinuation due to adverse events.
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Affiliation(s)
- Diaa-Eldin Taha
- Department of Urology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Omar M Aboumarzouk
- Greater Glasgow and Clyde NHS Trust, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ahmed A Shokeir
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Lee HY, Yun YJ, Choi JY, Hong JW, Lee I, Park SH, Kwon JN. Effectiveness and safety of moxibustion for alleviating symptoms of overactive bladder: A prospective, randomized controlled, crossover-design, pilot study. Medicine (Baltimore) 2018; 97:e12016. [PMID: 30142847 PMCID: PMC6113034 DOI: 10.1097/md.0000000000012016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to evaluate trial feasibility and explore the potential efficacy and safety of moxibustion in the treatment of overactive bladder (OAB). METHOD A randomized, controlled, cross-over, assessor blinded design was used. This study was conducted in an outpatient department of a university hospital in Republic of Korea. The overall study period was 8 weeks. Participants were randomly allotted to either Group A or Group B. Group A participants underwent 8 to 12 sessions of moxibustion with behavioral training during the first 4 weeks, while the Group B participants received behavioral training only. Over the next 4 weeks, the treatment offered to the 2 groups was reversed (Group A participants received behavioral training only, while Group B participants underwent the moxibustion session with behavioral training). The OAB-validated 8-question awareness tool (OAB-V8), OAB symptom scores (OABSS), visual analog scale (VAS) for lower urinary tract symptoms, and frequency voiding chart were used to assess outcomes. For analysis, we used effect size, measured as Hedge's g, to present descriptive results indicating the actual difference between the groups. RESULTS Compared to that in Group B, the Hedge's g of OAB-V8 for the former 4 weeks in Group A was -0.248, that of OABSS was -1.531, and that of VAS was -0.713. During the latter 4 weeks, Group B showed similar effect with g = 0.465, 1.207, and 0.427 for OAB-V8, OABSS, and VAS, respectively, compared to Group A. The portion of nocturnal voiding volume decreased (g = -0965), the mean voiding volume increased (g = 0.690), and the voiding frequency decreased (g = -0.498) with moxibustion. CONCLUSIONS Moxibustion might be considered as an alternative for OAB. A full-sized randomized controlled trial may be feasible with minimal modification in outcome measures and comparator population. OTHER INFORMATION This clinical trial has been registered on clinicaltrials.gov (NCT02271607).
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Affiliation(s)
- Hye-Yoon Lee
- Pusan National University Korean Medicine Hospital
| | - Young-Ju Yun
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Jun-Yong Choi
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Jin-Woo Hong
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - In Lee
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Seong-Ha Park
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
| | - Jung-Nam Kwon
- Pusan National University Korean Medicine Hospital
- School of Korean medicine, Pusan National University, Republic of Korea
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15
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Abstract
Nocturia is a widespread condition that can negatively impact quality of sleep and overall health. This condition is multifactorial in nature and is best approached through the analysis of frequency volume charts. Through these charts, clinicians may classify each individual case of nocturia into one of four distinct categories: global polyuria, nocturnal polyuria, reduced bladder capacity, and mixed. Treatments should then be tailored to each individual based upon the category of their nocturia. In some cases, appropriate therapy will consist of behavioral modification techniques or addressing underlying systemic diseases. In other cases, medical therapy may be necessary, but, to date, medications have shown limited efficacy at treating nocturia.
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Affiliation(s)
- Noam D. Fine
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jeffrey P. Weiss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Alan J. Wein
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania , USA
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Krystal AD, Preud’homme XA. Double-Blind, Placebo-Controlled, Crossover Study of Armodafinil Treatment of Daytime Sleepiness Associated With Treated Nocturia. Sleep 2016; 40:2666706. [DOI: 10.1093/sleep/zsw020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/14/2022] Open
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Tyagi S, Perera S, Clarkson BD, Tadic SD, Resnick NM. Nocturnal Polyuria in Older Women with Urge Urinary Incontinence: Role of Sleep Quality, Time in Bed and Medications Used. J Urol 2016; 197:753-758. [PMID: 27678299 DOI: 10.1016/j.juro.2016.09.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Nocturia is common and bothersome in older adults, especially those who are also incontinent. Since nocturnal polyuria is a major contributor, we examined factors associated with nocturnal polyuria in this population to identify those possibly amenable to intervention. MATERIALS AND METHODS We analyzed baseline data from 2 previously completed studies of urge urinary incontinence. The studies involved 284 women (mean age ± SD 72.9 ± 7.9 years) who also completed 3-day voiding diaries. Participants with a nocturnal polyuria index greater than 33% were categorized as having nocturnal polyuria (nocturnal polyuria index = nocturnal urinary volume per 24-hour urine volume). Associations between nocturnal polyuria and various demographic, clinical and sleep related parameters were determined. RESULTS Overall 55% of the participants had nocturnal polyuria. Multivariable regression analysis revealed that age, body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker, time spent in bed and duration of first uninterrupted sleep were independent correlates of nocturnal polyuria. Participants with a larger nocturnal excretion reported a shorter duration of uninterrupted sleep before first awakening to void and worse sleep quality despite spending similar time in bed. CONCLUSIONS Body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blockers, time in bed and duration of uninterrupted sleep before first awakening to void are independently associated with nocturnal polyuria in older women with urge urinary incontinence, and are potentially modifiable. These findings also confirm the association between sleep and nocturnal polyuria. Further studies should explore whether interventions to reduce nocturnal polyuria and/or increase the duration of uninterrupted sleep before first awakening to void would help to improve sleep quality in this population and thereby reduce or eliminate the need for sedative hypnotics.
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Affiliation(s)
- Shachi Tyagi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Subashan Perera
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Becky D Clarkson
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stasa D Tadic
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neil M Resnick
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Vicente E, Barrio M, Gual J, Fadil Y, Capdevila M, Muñoz J, Garcia D, Hannaoui N, Prats J. Spanish (Spain) validation of a specific symptomatic questionnaire for male patients with nocturia. Neurourol Urodyn 2016; 35:847-50. [DOI: 10.1002/nau.22814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/29/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Eduardo Vicente
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Míriam Barrio
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Josep Gual
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Younes Fadil
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Marta Capdevila
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Jesús Muñoz
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Darío Garcia
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Naim Hannaoui
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Joan Prats
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
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20
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Abstract
Nocturia is an extremely common condition that has major sequelae for affected patients. Through disruption of sleep, nocturia impairs quality of life and worsens health outcomes, and is associated with a variety of morbidities including diabetes, coronary artery disease, obstructive sleep apnoea, obesity, metabolic syndrome, and depression. Unsurprisingly, several studies have also linked nocturia with reduced survival. Nocturia is not simply a consequence of lower urinary tract disease; rather, it is a multifactorial disorder that is often a manifestation of an underlying renal or systemic disease. Through the use of the frequency volume chart, clinicians can accurately quantify nocturia and determine its aetiology. Evaluation of quality of life and sleep using simple measures is essential in order to assess the impact of nocturia on a patient. Numerous treatment options for nocturia exist, but most are associated with minor benefit or lack sufficient evidence supporting their use. By systematically analysing an individual's causes of nocturia, clinicians can design appropriate treatment strategies to most effectively treat this condition.
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Affiliation(s)
- Hasan Dani
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
| | - Ashanda Esdaille
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
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21
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Endeshaw YW, Schwartz AV, Stone K, Caserotti P, Harris T, Smagula S, Satterfield S. Nocturia, Insomnia Symptoms and Mortality among Older Men: The Health, Aging and Body Composition Study. J Clin Sleep Med 2016; 12:789-96. [PMID: 26951411 DOI: 10.5664/jcsm.5870] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the association between nocturia (walking up from sleep for urination) and mortality risk among community dwelling older men. METHODS This is a secondary data analysis using data obtained from the Health Aging Body Composition (Health ABC) study. Frequency of nocturia was determined at baseline using a questionnaire. RESULTS A total of 1,478 older men, mean (SD) age 73.8 (2.9) years, were included in the analysis. During a follow up period of 9.9 years, a total of 760 deaths were reported. Mortality rate was significantly higher for participants with 3 or more nocturia episodes per night, in comparison to those with 0-1 episodes (HR [CI] : 1.21 [1.00-1.47], p = 0.055), even after controlling for baseline characteristics which included demographic variables, body mass index, lower urinary tract symptoms, use of loop diuretics, insomnia symptoms, feeling excessively sleepy during the day/daytime naps, sleep duration, and use of sleep medications. However, the association between ≥ 3 nocturia episodes per night and mortality risk was no longer statistically significant once prevalent diabetes mellitus and cardiovascular disease were included in the model (HR [CI]: 1.18 [0.97- 1.44], p = 0.100). CONCLUSIONS Nocturia is associated with mortality independent of insomnia symptoms and sleep duration. The relationship is explained in part by prevalent cardiovascular disease and diabetes mellitus. The results underscore the impact of these medical conditions on the association between 3 or more nocturia episodes and increased mortality risk among older men.
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Affiliation(s)
- Yohannes W Endeshaw
- Geriatrics Section, Department of Medicine, Morehouse School of Medicine, Atlanta GA
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Paolo Caserotti
- University of Southern Denmark-Institute of Sports Science and Clinical Biomechanics, Odense, Denmark
| | - Tamara Harris
- Intramural Research Program, Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, MD
| | - Stephen Smagula
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Health Science Center, Memphis, TN
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22
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Kim JW, Moon YT, Kim KD. Nocturia: The circadian voiding disorder. Investig Clin Urol 2016; 57:165-73. [PMID: 27195315 PMCID: PMC4869573 DOI: 10.4111/icu.2016.57.3.165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022] Open
Abstract
Nocturia is a prevalent condition of waking to void during the night. The concept of nocturia has evolved from being a symptomatic aspect of disease associated with the prostate or bladder to a form of lower urinary tract disorder. However, recent advances in circadian biology and sleep science suggest that it might be important to consider nocturia as a form of circadian dysfunction. In the current review, nocturia is reexamined with an introduction to sleep disorders and recent findings in circadian biology in an attempt to highlight the importance of rediscovering nocturia as a problem of chronobiology.
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Affiliation(s)
- Jin Wook Kim
- Department of Urology, Chung-Ang University, Seoul, Korea
| | - Young Tae Moon
- Department of Urology, Chung-Ang University, Seoul, Korea
| | - Kyung Do Kim
- Department of Urology, Chung-Ang University, Seoul, Korea
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23
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Chen SL, Huang YH, Hung TW, Ou YC. Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice. Int J Clin Pract 2016; 70:372-9. [PMID: 27039892 DOI: 10.1111/ijcp.12786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of low-dose desmopressin in elderly men with and without nocturnal polyuria (NP) in real-life practice. METHODS Patients with lower urinary tract symptoms (LUTS)/ benign prostate hyperplasia (BPH) who were≧ 65 years old with refractory nocturia were enrolled in this study. We retrospectively analysed elderly men treated with adding desmopressin to current medications for nocturia according to category of the baseline nocturnal urine volume. The 48-h frequency volume chart (FVC), International Prostate Symptom Score (IPSS) and quality of life (QoL) were initially assessed and re-evaluated 12 weeks later. Serum sodium level was checked 1 week, 4 weeks, and 12 weeks after initiation of desmopressin therapy or suspected hyponatremia event. The mean change in numbers of nocturnal voids was evaluated for efficacy of treatment. RESULTS A total of 136 patients were included with 55 in non-NP group and 81 in NP group. Hypertension was more common in NP group in regard of comorbidities. During treatment period, there were significant reductions of nocturnal voids from 4.22 ± 1.38 to 2.31 ± 0.98 (p < 0.001) in non-NP group and from 4.52 ± 1.23 to 2.07 ± 0.89 (p < 0.001) in NP group. The reduction in nocturnal voids was more significant in NP group (2.44 ± 1.15 vs. 1.91 ± 1.48, p = 0.003). The mean decrease in serum sodium levels were 3.89 ± 1.22 mmol/l (p < 0.001) in non-NP group and 4.69 ± 3.5 mmol/l (p < 0.001) in NP group at the extreme value. CONCLUSIONS Long-term treatment with low-dose desmopressin is safe and effective for nocturia with or without NP in elderly patients with LUTS/BPH during real-life practice. Patients should be well informed about the disease and are closely followed.
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Affiliation(s)
- S-L Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Y-H Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - T-W Hung
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nephrology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-C Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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24
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Niimi A, Suzuki M, Yamaguchi Y, Ishii M, Fujimura T, Nakagawa T, Fukuhara H, Kume H, Igawa Y, Akishita M, Homma Y. Sleep Apnea and Circadian Extracellular Fluid Change as Independent Factors for Nocturnal Polyuria. J Urol 2016; 196:1183-9. [PMID: 27105762 DOI: 10.1016/j.juro.2016.04.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We investigated the relationships among nocturnal polyuria, sleep apnea and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome. MATERIALS AND METHODS We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were administered to evaluate sleep disorder and lower urinary tract symptoms, including nocturia. Voiding frequency and voided volume were recorded using a 24-hour frequency-volume chart. Body fluid composition was estimated in the morning and at night using bioelectric impedance analysis. Frequency-volume chart data were analyzed in 22 patients after continuous positive airway pressure therapy. RESULTS Patients with nocturnal polyuria showed a higher apnea-hypopnea index (33.9 vs 24.2, p = 0.03) and a larger circadian change in extracellular fluid adjusted to lean body mass (0.22 vs -0.19, p = 0.019) than those without nocturnal polyuria. These relations were more evident in patients 65 years old or older than in those 64 years or younger. A multivariate linear regression model showed an independent relationship of nocturnal polyuria with the apnea-hypopnea index and the circadian change in extracellular fluid adjusted to lean body mass (p = 0.0012 and 0.022, respectively). Continuous positive airway pressure therapy significantly improved nocturnal polyuria and nocturia only in patients with nocturnal polyuria. CONCLUSIONS This study identified sleep apnea and the circadian change in extracellular fluid as independent factors for nocturnal polyuria.
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Affiliation(s)
- Aya Niimi
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Yasuhiro Yamaguchi
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Masaki Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Drake MJ, Chapple C, Esen AA, Athanasiou S, Cambronero J, Mitcheson D, Herschorn S, Saleem T, Huang M, Siddiqui E, Stölzel M, Herholdt C, MacDiarmid S. Efficacy and Safety of Mirabegron Add-on Therapy to Solifenacin in Incontinent Overactive Bladder Patients with an Inadequate Response to Initial 4-Week Solifenacin Monotherapy: A Randomised Double-blind Multicentre Phase 3B Study (BESIDE). Eur Urol 2016; 70:136-145. [PMID: 26965560 DOI: 10.1016/j.eururo.2016.02.030] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/08/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Incontinence has a greater detrimental effect on quality of life than other symptoms of overactive bladder (OAB) and is often difficult to treat with antimuscarinic monotherapy. OBJECTIVE To evaluate the efficacy and the safety and tolerability of combination (solifenacin 5mg and mirabegron 50mg) versus solifenacin 5 or 10mg in OAB patients remaining incontinent after 4 wk of solifenacin 5mg. DESIGN, SETTING, AND PARTICIPANTS OAB patients remaining incontinent despite daily solifenacin 5mg during 4-wk single-blind run-in were randomised 1:1:1 to double-blind daily combination or solifenacin 5 or 10mg for 12 wk. Patients receiving the combination were initiated on mirabegron 25mg increasing to 50mg after week 4. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was a change from baseline to end of treatment (EOT) in the mean number of incontinence episodes per 24h (stratified rank analysis of covariance [ANCOVA]). Key secondary end points were a change from baseline to EOT in the mean number of micturitions per 24h (ANCOVA) and number of incontinence episodes noted in a 3-d diary at EOT (mixed-effects Poisson regression). A trial (BESIDE) comparing combination treatment (solifenacin plus mirabegron) with one treatment alone (solifenacin) tested the superiority of combination versus solifenacin 5mg, noninferiority (and potential superiority) of combination versus solifenacin 10mg (key secondary end points), and the safety and tolerability of combination therapy versus solifenacin monotherapy. RESULTS AND LIMITATIONS A total of 2174 patients were randomised to combination (n=727), solifenacin 5mg (n=728), or solifenacin 10mg (n=719). At EOT, combination was superior to solifenacin 5mg, with significant improvements in daily incontinence (p=0.001), daily micturitions (p<0.001), and incontinence noted in a 3-d diary (p=0.014). Combination was noninferior to solifenacin 10mg for key secondary end points and superior to solifenacin 10mg for improving daily micturitions. All treatments were well tolerated. CONCLUSIONS Adding mirabegron 50mg to solifenacin 5mg further improved OAB symptoms versus solifenacin 5 or 10mg, and it was well tolerated in OAB patients remaining incontinent after initial solifenacin 5mg. PATIENT SUMMARY In this 12-wk study, overactive bladder patients who remained incontinent despite initial solifenacin 5mg treatment received additional treatment with mirabegron 50mg. Combining mirabegron 50mg with solifenacin 5mg was superior to solifenacin 5mg alone in improving symptoms of incontinence and frequent urination, and it was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov NCT01908829.
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Affiliation(s)
- Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, UK.
| | | | - Ahmet A Esen
- Dokuz Eylül University School of Medicine, İzmir, Turkey
| | | | | | | | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tahir Saleem
- Astellas Pharma Europe Ltd, Chertsey, Surrey, UK
| | - Moses Huang
- Astellas Pharma Europe Ltd, Chertsey, Surrey, UK
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Kim BH, Kim KH, Ko YH, Song PH, Kim TH, Kim BS. The prostatic urethral angle can predict the response to alpha adrenoceptor antagonist monotherapy for treating nocturia in men with lower urinary tract symptom: A multicenter study. Prostate Int 2016; 4:30-5. [PMID: 27014662 PMCID: PMC4789331 DOI: 10.1016/j.prnil.2015.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We evaluated ultrasonography variables associated with the improvement of nocturia after administration of alpha adrenoceptor antagonist (alpha blocker) monotherapy. METHODS From February to October 2014, 679 men with lower urinary tract symptoms (LUTS) underwent ultrasonography including prostate volume, transitional zone volume, prostatic urethral length, the ratio between prostatic urethral length and prostate volume (RPUL), intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA). Among them, 108 men who had pre-treatment nocturia without nocturnal polyuria (nocturnal polyuria index < 33%) and were treated with alpha blocker monotherapy over 3 months were enrolled. Patients were divided into the improved (< 2 times of nocturia) and non-improved group (more than 2 times) after administration of alpha blockers. Along with ultrasonography, international prostate symptom score (IPSS) and uroflowmetry was assessed. RESULTS After alpha blocker treatment, 25.0% of patients (27/108) showed improvement of nocturia. These patients were significantly younger (59.6 vs 68.0 years, P = < 0.001) with lower PUA (31.8 vs. 39.4°, P = 0.009) compared with the non-improved group. In ROC analysis, the area under the curve using the PUA was 0.653 (95% CI = 0.532-0.774, P = 0.018). Using 33.5° as a cut-off level, the sensitivity and specificity for predicting the improvement of nocturia after medication reached 67.9% and 55.6%, respectively. Patients with lower PUA (PUA < 33.5°) had more improvement of nocturia (36.6 vs. 17.9%, P = 0.030), lower IPSS score (14.2 vs. 18.3, P = 0.005), and better quality of life index (3.1 vs 3.8, P = 0.021). CONCLUSIONS In the patients with lower PUA (particularly lower than 33.5°), nocturia was improved by administration of alpha blocker monotherapy.
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Affiliation(s)
- Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, South Korea
| | - Ki Ho Kim
- Department of Urology, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Young Hwii Ko
- Department of Urology, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Phil Hyun Song
- Department of Urology, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Tae-Hwan Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea
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27
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Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z. Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. Int J Clin Pract 2015; 69:1508-16. [PMID: 26351086 DOI: 10.1111/ijcp.12727] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the risk factors and comorbidities associated with nocturia in men and women aged ≥ 40 years. MATERIAL AND METHODS The EpiLUTS study was an Internet-based cross-sectional, population-representative survey involving 30,000 men and women from the USA, UK and Sweden evaluating lower urinary tract symptoms (LUTS) using the LUTS Tool. A secondary analysis of the EpiLUTS data using participants with nocturia was performed. Descriptive statistics were used to examine the data. Logistic regressions were used to analyse associations of comorbid conditions and risk factors in men and women with nocturia ≥ 2. RESULTS With a 59% response rate, nocturia ≥ 1 was quite common at 69% in men and 76% in women; 28% men and 34% women had nocturia ≥ 2. Age, body mass index (in women), Hispanic and Black responders, diabetes, high blood pressure, anxiety and depression and a history of bed-wetting were significantly associated with nocturia ≥ 2. Arthritis, asthma, diabetes, heart disease, inflammatory bowel disease, bladder infection, uterine prolapse, hysterectomy and menopausal status were all significantly associated with nocturia ≥ 2 in women. Prostatitis and prostate cancer were significant in men with nocturia ≥ 2. British and Swedish participants had a lesser risk of nocturia ≥ 2. CONCLUSION Nocturia is a highly prevalent condition associated with various risk factors and comorbidities. Treatment of nocturia should be aimed at these causes in a multidisciplinary fashion. Further studies are needed to look specifically at these conditions in the pathophysiology of nocturia.
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Affiliation(s)
- C Madhu
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | - H Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - C Chapple
- The Royal Hallamshire Hospital, Sheffield, UK
| | - I Milsom
- The Department of Obstetrics & Gynecology, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
| | - Z Kopp
- Pfizer Outcomes Research, New York, NY, USA
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Avulova S, Blanker MH, van Doorn B, Weiss JP, Bosch JLHR, Tsui JF, Khusid JA, Golombos D, Blaivas JG. Determinants of nocturia severity in men, derived from frequency-volume charts. Scand J Urol 2014; 49:185-8. [PMID: 25363610 DOI: 10.3109/21681805.2014.973901] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Nocturia may be characterized by indices derived from the frequency-volume chart (FVC). The objective of this study was to determine how these parameters relate to the severity of nocturia in men with and without lower urinary tract symptoms (LUTS). MATERIALS AND METHODS A retrospective analysis of FVCs was performed in two cohorts of men: those presenting with LUTS in a New York ambulatory urology clinic and those from the longitudinal population-based Krimpen study. Nocturnal urine volume (NUV), nocturia index (Ni), nocturnal polyuria index (NPi), nocturnal maximal voided volume (nMVV) and sleep duration were derived from FVCs. Comparisons were made using Spearman's rank correlation coefficient between actual number of nightly voids (ANV) and the other diary parameters. RESULTS Eighty-eight consecutive men who presented with LUTS completed a 24 h FVC [median age 70 years, interquartile range (IQR) 64.5-74.5, median ANV 2, IQR 1.5-4]. Nocturnal voiding frequency and volume were analyzed in 1082 community-dwelling men (median age 61 years, IQR 56.1-66.4, range 49.4-78.2; median ANV 1.5, IQR 1.0-2.0, range 0-4.5). Both cohorts demonstrated strong correlations between nocturia severity (represented as ANV) and Ni (0.797, 0.658 for cohorts 1 and 2, respectively). There were moderate correlations between nocturia severity and NPi (0.545, 0.394), NUV (0.463, 0.432) and sleep duration (0.306, 0.272). The nMVV correlated poorly with nocturia severity (0.159, 0.146). CONCLUSIONS Treatment of nocturia should aim to match nocturnal urine production with bladder capacity. Given the lack of known effective pharmacotherapy for low bladder volume, the first attempt nocturia treatment could focus on volume reduction.
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Affiliation(s)
- Svetlana Avulova
- Department of Urology, SUNY Downstate College of Medicine , Brooklyn, NY , USA
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Wang Y, Hu H, Xu K, Zhang X, Wang X, Na Y, Kang X. Prevalence, risk factors, and symptom bother of nocturia: a population-based survey in China. World J Urol 2014; 33:677-83. [DOI: 10.1007/s00345-014-1411-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022] Open
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Song M, Hong BS, Chun JY, Han JY, Choo MS. Safety and efficacy of desmopressin for the treatment of nocturia in elderly patients: a cohort study. Int Urol Nephrol 2014; 46:1495-9. [PMID: 24595604 DOI: 10.1007/s11255-014-0679-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Desmopressin is used widely to treat nocturnal polyuria (NP), but there is concern of hyponatremia especially in elderly patients. This study aimed to evaluate the safety and efficacy of long-term desmopressin treatment in elderly patients with NP. METHODS Patients who were ≥65 years old with NP were analyzed. All patients were started on 0.1 mg desmopressin, and the dose was escalated to 0.2 mg depending on patient symptoms. All patients were educated the mechanism of desmopressin. The voiding diary and serum sodium levels were evaluated at baseline, 3-7 days after starting treatment and every 3-6 months. Safety was evaluated by hyponatremia, hyponatremic symptoms and other adverse drug events. The mean changes in number of nocturia and nocturnal urine volume (NUV) were evaluated for efficacy. RESULTS A total of 68 patients were included. The mean age was 72.6 (66-85) years. The mean night-time frequency was 3.0 ± 1.8 day, and the mean serum sodium level was 141.2 ± 2.1 mEq/L at baseline. The mean follow-up period was 27.9 months. The mean decrease in serum sodium level was 1.3 ± 3.4 mEq/L at the last follow-up (p = 0.003). Hyponatremia incidence was 4.4 %, and all patients recovered by stopping medication. Severe adverse events were not observed. The mean night-time frequency had decreased by 2.1, and the NUV had decreased by 374.2 ± 261.3 mL at the last follow-up (p < 0.001). CONCLUSIONS Desmopressin at doses below 0.2 mg is safe and effective in elderly patients with NP if patients are well informed and are closely followed up.
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Affiliation(s)
- Miho Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Allen AM, Coon DW, Uriri-Glover J, Grando V. Factors Associated With Sleep Disturbance Among Older Adults in Inpatient Rehabilitation Facilities. Rehabil Nurs 2013; 38:221-30. [DOI: 10.1002/rnj.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 11/11/2022]
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Doo SW, Kim JH, Yang WJ, Song YS. Is There Any Objective Improvement of Nocturia by Combination Treatment of Zolpidem and Alpha-Blocker Therapy for Unresponsive to Alpha-Blocker Monotherapy in Men with Lower Urinary Tract Symptoms? Low Urin Tract Symptoms 2013; 5:134-9. [PMID: 26663448 DOI: 10.1111/luts.12001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the present study was to determine whether administration of zolpidem, a nonbenzodiazepine sedative-hypnotic agent, at night would improve the nocturia unresponsive to alpha-blocker monotherapy in men with lower urinary tract symptoms (LUTS). METHODS This was a prospective observational study comprised of 39 men aged 50 years and older. The study inclusion criteria were age more than 50 years, and nocturia twice or more per night after taking alpha-blockers for more than 8 weeks. A total of 39 patients met the criteria and constituted the study cohort. Pittsburgh Sleep Quality Index (PSQI), International Prostate Symptom Score (IPSS), frequency volume chart (FVCs) and uroflowmetry were recorded. Patients were given 10 mg alfuzosin and 10 mg zolpidem once at night for the 8 weeks. RESULTS There were no serious side-effects in any patient. Nocturia decreased from a baseline (3.1 ± 0.1) to 8 weeks (1.6 ± 0.2) (P = 0.001). After treatment, global PSQI scores and severe sleep disorders improved. Storage and voiding symptoms including total IPSS scores and quality of life index improved. Nocturnal urine volume and functional bladder capacity improved. Maximum flow rate, voided volume increased and residual urine volume decreased. CONCLUSION Combined zolpidem and alpha-blocker therapy resulted in a subjective and objective reduction in nocturia episodes when given to men with nocturia unresponsive to alpha-blocker monotherapy.
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Affiliation(s)
- Seung Whan Doo
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Bae WJ, Bae JH, Kim SW, Chung BH, Kim JH, Kim CS, Lee HM, Lee KS, Yoo TK, Kim SI, Byun SS, Lee JY. Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms. J Urol 2013; 190:180-6. [DOI: 10.1016/j.juro.2013.01.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jang Ho Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Jang Hwan Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Choung Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kyung Seop Lee
- Department of Urology, Dongguk University, Kyungnam, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji University, Seoul, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University, Bundang Hospital, Kyungki, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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van Doorn B, Blanker MH, Kok ET, Westers P, Bosch JR. Prevalence, Incidence, and Resolution of Nocturnal Polyuria in a Longitudinal Community-based Study in Older Men: The Krimpen Study. Eur Urol 2013; 63:542-7. [DOI: 10.1016/j.eururo.2012.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
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Sato M, Yasuhara Y, Tanioka T, Iwasa Y, Miyake M, Kobayashi H, Locsin RC, Kinoshita S, Masuda M, Shimizu H. The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus. Health (London) 2013. [DOI: 10.4236/health.2013.511253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Helfand BT, Lee JY, Sharp V, Foster H, Naslund M, Williams OD, McVary KT. Associations between improvements in lower urinary tract symptoms and sleep disturbance over time in the CAMUS trial. J Urol 2012; 188:2288-93. [PMID: 23083656 DOI: 10.1016/j.juro.2012.07.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Indexed: 01/23/2023]
Abstract
PURPOSE We recently reported an association between the bother and severity of lower urinary tract symptoms secondary to benign prostatic hyperplasia and the severity of sleep disturbance. However, few studies have examined whether alterations in the severity of urinary symptoms influence the degree of sleep problems over time. MATERIALS AND METHODS The severity of lower urinary tract symptoms in men enrolled in CAMUS (Complementary and Alternative Medicine for Urological Symptoms), a clinical trial of saw palmetto (Serenoa repens), was evaluated using AUASI (American Urological Association symptom index) and quality of life scores. Sleep disturbance was evaluated by the Jenkins sleep scale at 0, 24, 48 and 72 weeks. Statistical analyses were used to assess the relationship(s) between changes in lower urinary tract symptoms and sleep disturbance. RESULTS The baseline characteristics of the 339 men (172 placebo arm and 167 saw palmetto arm) enrolled in the CAMUS trial with assessment of sleep disturbance and urinary symptoms were similar. There were no differences between improvements in the severity of sleep disturbance or urinary symptoms between the 2 experimental arms. Combined analyses of the entire cohort revealed significant associations (p <0.001) between the AUASI score and sleep disturbance severity with time. Multivariate analyses demonstrated that improvements in lower urinary tract symptoms other than nocturia were the most significant predictors of improvements in sleep disturbance. Specific analyses adjusting for other baseline characteristics demonstrated that a 3-point improvement in AUASI score was associated with a 0.73-point improvement in the Jenkins sleep scale with time. CONCLUSIONS Improvements in lower urinary tract symptoms correlate with changes in sleeping abilities with time in men with benign prostatic hyperplasia. While nocturia is significantly associated with sleep disturbance, other changes in overall lower urinary tract symptoms are better predictors of changes in sleep dysfunction.
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Affiliation(s)
- Brian T Helfand
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Bing MH, Jennum P, Moller LA, Mortensen S, Lose G. Obstructive sleep apnea in a Danish population of men and women aged 60-80 years with nocturia. J Clin Sleep Med 2012; 8:515-20. [PMID: 23066362 PMCID: PMC3459196 DOI: 10.5664/jcsm.2144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the present study was in a case-control design to evaluate the association between nocturia and obstructive sleep apnea, in men and women who had nocturia ≥ 2 per night (nocturics) compared to those without nocturia (controls). METHODS Participants were randomly selected among respondents in a population study of 4000 elderly individuals. Nocturia was assessed using the validated Nocturia, Nocturnal Enuresis, and Sleep-interruption Questionnaire (NNES-Q). Nocturia (≥ 2 voids/night) or control (< 1 void/night) status was assessed by a 3-day frequency volume chart (FVC). Furthermore, all participants completed an overnight ambulatory polygraphic recording to identify obstructive sleep apnea (OSA). RESULTS Of 1111 eligible individuals, a total of 75 nocturics and 75 controls (13.5%) were included. Overall, the prevalence and severity of OSA among nocturics and controls was not significantly different. In a sub-analysis we found that 22 nocturics with OSA (69%) had nocturnal polyuria. This led to a significantly increased risk of having OSA (OR 2.8, 95% CI: 1.1-7.3, p < 0.05) when having nocturnal polyuria compared to other pathophysiological causes of nocturia (polyuria, low bladder capacity, a combination of nocturnal polyuria/low bladder capacity, and neither nocturnal polyuria/low bladder capacity). CONCLUSIONS Nocturia twice or more was not significantly associated with OSA. However, nocturics with nocturnal polyuria had a significantly higher risk of having OSA than nocturics with other pathophysiologies.
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Affiliation(s)
- Mette Hornum Bing
- Department of Obstetrics and Gynaecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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van Haarst EP, Bosch JLHR. A cutoff value based on analysis of a reference population decreases overestimation of the prevalence of nocturnal polyuria. J Urol 2012; 188:869-73. [PMID: 22819414 DOI: 10.1016/j.juro.2012.04.112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought criteria for nocturnal polyuria in asymptomatic, nonurological adults of all ages by reporting reference values of the ratio of daytime and nighttime urine volumes, and finding nocturia predictors. MATERIALS AND METHODS Data from a database of frequency-volume charts from a reference population of 894 nonurological, asymptomatic volunteers of all age groups were analyzed. The nocturnal polyuria index and the nocturia index were calculated and factors influencing these values were determined by multivariate analysis. RESULTS The nocturnal polyuria index had wide variation but a normal distribution with a mean ± SD of 30% ± 12%. The 95th percentile of the values was 53%. Above this cutoff a patient had nocturnal polyuria. This value contrasts with the International Continence Society definition of 33% but agrees with several other reports. On multivariate regression analysis with the nocturnal polyuria index as the dependent variable sleeping time, maximum voided volume and age were the covariates. However, the increase in the nocturnal polyuria index by age was small. Excluding polyuria and nocturia from analysis did not alter the results in a relevant way. The nocturnal voiding frequency depended on sleeping time and maximum voided volume but most of all on the nocturia index. CONCLUSIONS The prevalence of nocturnal polyuria is overestimated. We suggest a new cutoff value for the nocturnal polyuria index, that is nocturnal polyuria exists when the nocturnal polyuria index exceeds 53%. The nocturia index is the best predictor of nocturia.
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Affiliation(s)
- Ernst P van Haarst
- Department of Urology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
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Abstract
Until last decades, nocturia has been considered as an irritative symptom of benign prostatic hyperplasia (BPH), but the nocturia is unresponsive symptoms to various modalities of BPH treatment. More recently, it has been recognized that the prostate is not so quite important as previously believed, as nocturia is equally common in women. The understanding of nocturia has been much changed in last decade; it is a highly prevalent condition, and symptoms in men and women are really no different either quantitatively or qualitatively. The successful introduction of desmopressin (l-deamino-8-D-arginine vasopressin, DDAVP) to decrease nocturnal urine output in severe nocturia which resistant to conventional BPH treatment and in women demonstrated new perspectives in management of nocturia. We reviewed the definition and etiologies of nocturia, offering the current diagnostic procedures and standards of care.
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Affiliation(s)
- Myeong Heon Jin
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Murphy AM, Goldman HB. Clinical trials report: low-dose oral desmopressin for nocturia. Curr Urol Rep 2011; 12:313-5. [PMID: 21503733 DOI: 10.1007/s11934-011-0195-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Alana M Murphy
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, The Cleveland Clinic, Euclid Avenue/Q10, Cleveland, OH 44195, USA
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Simaioforidis V, Papatsoris AG, Chrisofos M, Chrisafis M, Koritsiadis S, Deliveliotis C. Tamsulosin versus transurethral resection of the prostate: Effect on nocturia as a result of benign prostatic hyperplasia. Int J Urol 2011; 18:243-8. [DOI: 10.1111/j.1442-2042.2010.02704.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Short term effect and safety of antidiuretic hormone in the patients with nocturia. Int Neurourol J 2010; 14:227-31. [PMID: 21253333 PMCID: PMC3021813 DOI: 10.5213/inj.2010.14.4.227] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/21/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate the short-term safety of antidiuretic hormone in elderly patients with nocturnal polyuria, focus on hyponatremia and others electrolytes disturbances and to assess short-term effects on nocturnal urine output and number of nocturnal voids. METHODS Between June 2005 and August 2006, a total of 34 patients with nocturnal polyuria were orally administered 0.2 mg desmopressin tablet at bedtime for two weeks. Serum sodium, others electrolytes, urine sodium and urine osmolarity were assessed in the third days, one week and two weeks after treatment with desmopressin and compared adult group (<65 years of age) with elderly group (≥65 years of age). We assessed the effect of desmopressin using a frequency-volume charts and analysed. RESULTS In total 34 patients (20 adult, 14 elderly) were analyzed. Desmopressin treatment did not significantly change serum and urine electrolytes include soduim concentration in elderly patients comparied with adult patients. Serum sodium concentration below normal range was recorded in 2 patients in elderly group, but no serious adverse events occurred and recovered without sequelae. The mean number of nocturnal voids decresed (54% reduction) and nocturnal urine output decreased (57% reduction) after using desmopressin. CONCLUSIONS Desmopressin was well tolerated and effective in elderly patients with nocturnal polyuria without clinically significant hyponatremia.
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Lee HW, Choo MS, Lee JG, Park CH, Paick JS, Lee JZ, Han DH, Park WH, Lee KS. Desmopressin is an effective treatment for mixed nocturia with nocturnal polyuria and decreased nocturnal bladder capacity. J Korean Med Sci 2010; 25:1792-7. [PMID: 21165296 PMCID: PMC2995235 DOI: 10.3346/jkms.2010.25.12.1792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/22/2010] [Indexed: 11/20/2022] Open
Abstract
To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged ≥ 18 yr with mixed nocturia (≥ 2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4 ± 44.1 to 220.3 ± 90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.
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Affiliation(s)
- Hye Won Lee
- Department of Integrative Bioscience and Biotechnology, Pohang University of Science and Technology, Pohang, Korea
| | - Myung-Soo Choo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Korea
| | - Choal Hee Park
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Zoo Lee
- Department of Urology, Pusan National University Hospital, Busan, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Hee Park
- Department of Urology, College of Medicine Inha University, Incheon, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wang CJ, Lin YN, Huang SW, Chang CH. Low dose oral desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia: a double-blind, placebo controlled, randomized study. J Urol 2010; 185:219-23. [PMID: 21074790 DOI: 10.1016/j.juro.2010.08.095] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30% of total daily urine volume. MATERIALS AND METHODS Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia, nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study. All patients received placebo or 0.1 mg desmopressin orally at bedtime. Patients were required to visit the outpatient clinic from the first visit, and after 1, 3, 6 and 12 months of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. During followup urinalysis, urine sodium, urine osmolality, serum electrolytes, prostate specific antigen, International Prostate Symptom Score, quality of life, transrectal ultrasonography of prostate, uroflowmetry and post-void residual urine volume were performed at each visit. RESULTS A total of 115 patients were enrolled in the study and randomized as 58 in the placebo group and 57 in the desmopressin group. Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes, and prolonged the first sleep period (p < 0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 12 months of treatment. No serious systemic complications were found during medication. CONCLUSIONS Low dose oral desmopressin is an effective and well tolerated treatment for nocturnal polyuria in the lower urinary tract symptoms of patients with benign prostatic hyperplasia. Long-term desmopressin therapy gradually decreases serum sodium and it might induce hyponatremia even in patients without initial hyponatremia. For long-term desmopressin administration serum sodium should be assessed carefully, at least at 1 week after treatment.
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Affiliation(s)
- Chung-Jing Wang
- Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.
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Krystal AD, Preud'homme XA, Amundsen CL, Webster GD. Detrusor overactivity persisting at night and preceding nocturia in patients with overactive bladder syndrome: a nocturnal cystometrogram and polysomnogram study. J Urol 2010; 184:623-8. [PMID: 20639027 DOI: 10.1016/j.juro.2010.03.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE Nocturia, a common symptom of overactive bladder syndrome, is associated with substantial adverse consequences and yet its pathophysiology has hardly been studied and the capacity to treat it remains limited. We established methods to study the physiology of overactive bladder associated nocturia and better understand this phenomenon. MATERIALS AND METHODS We recorded simultaneous, time aligned, nocturnal cystometrogram and polysomnogram data during a single night at a sleep laboratory in 9 patients with overactive bladder and detrusor overactivity on daytime cystometrogram, in 10 patients with insomnia and in 5 healthy controls. RESULTS We safely recorded simultaneous polysomnography/nocturnal cystometrography data accurately during the sleep period. Nocturnal detrusor overactivity occurred significantly less often in patients with insomnia and controls than in patients with detrusor overactivity plus overactive bladder (p = 0.02) and only in the 10 minutes before nocturia events in the latter (0%, 0% and 67%, respectively, p = 0.002). Patients with detrusor overactivity plus overactive bladder were awake for a shorter period before nocturia events (p <0.001) and had a greater percent of nocturia associated awakenings. Patients with insomnia had more awakenings unrelated to nocturia. Nocturnal polyuria, another cause of nocturia, was not significantly associated with nocturnal detrusor overactivity. CONCLUSIONS Sleep and bladder pressure physiology may be safely monitored during the sleep period accurately. Nocturnal detrusor overactivity occurs in association with nocturia in most patients with detrusor overactivity plus overactive bladder, does not generally occur during sleep and is not due to sleep disturbance or nocturnal polyuria. This study may provide a foundation for research on overactive bladder related nocturia pathophysiology and treatment.
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Affiliation(s)
- Andrew D Krystal
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Yoshida M, Inadome A, Masunaga K, Nagata T, Yoshiyasu T. Effectiveness of tamsulosin hydrochloride and its mechanism in improving nocturia associated with lower urinary tract symptoms/benign prostatic hyperplasia. Neurourol Urodyn 2010; 29:1276-81. [DOI: 10.1002/nau.20872] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Udo Y, Nakao M, Honjo H, Ukimura O, Kitakoji H, Miki T. Sleep duration is an independent factor in nocturia: analysis of bladder diaries. BJU Int 2009; 104:75-9. [DOI: 10.1111/j.1464-410x.2009.08379.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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