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Wolff DT, Monaghan TF, Gordon DJ, Michelson KP, Jones T, Khargi R, Smith MT, Maffucci F, Kwun H, Suss NR, Winer AG. Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database. ACTA ACUST UNITED AC 2021; 57:medicina57070671. [PMID: 34209546 PMCID: PMC8303448 DOI: 10.3390/medicina57070671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The National Cancer Database (NCDB) captures nearly 70% of all new cancer diagnoses in the United States, but there exists significant variation in this capture rate based on primary tumor location and other patient demographic factors. Prostate cancer has the lowest coverage rate of all major cancers, and other genitourinary malignancies likewise fall below the average NCDB case coverage rate. We aimed to explore NCDB coverage rates for patients with genitourinary cancers as a function of race. Materials and Methods: We compared the incidence of cancer cases in the NCDB with contemporary United States Cancer Statistics data. Results: Across all malignancies, American Indian/Alaskan Natives subjects demonstrated the lowest capture rates, and Asian/Pacific Islander subjects exhibited the second-lowest capture rates. Between White and Black subjects, capture rates were significantly higher for White subjects overall and for prostate cancer and kidney cancer in White males, but significantly higher for bladder cancer in Black versus White females. No significant differences were observed in coverage rates for kidney cancer in females, bladder cancer in males, penile cancer, or testicular cancer in White versus Black patients. Conclusions: Differential access to Commission on Cancer-accredited treatment facilities for racial minorities with genitourinary cancer constitutes a unique avenue for health equity research.
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Affiliation(s)
- Dylan T. Wolff
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Thomas F. Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
| | - Danielle J. Gordon
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Kyle P. Michelson
- Department of Urology, University of South Florida, Tampa, FL 33606, USA;
| | - Tashzna Jones
- Department of Urology, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Raymond Khargi
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Matthew T. Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Fenizia Maffucci
- Department of Urology, Temple University Hospital, Philadelphia, PA 19104, USA;
| | - Hyezo Kwun
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Nicholas R. Suss
- Department of Surgery, University of Chicago, Chicago, IL 60637, USA;
| | - Andrew G. Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (D.J.G.); (R.K.); (M.T.S.); (A.G.W.)
- Department of Urology, Kings County Hospital Center, Brooklyn, NY 11203, USA
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Mekki P, Monaghan TF, Lee L, Agudelo CW, Gong F, George CD, Michelson KP, Wu ZD, Weiss JP, Everaert K, Dmochowski RR, Bliwise DL, Wein AJ, Lazar JM. Nocturia and electrocardiographic abnormalities among patients at an inner-city cardiology clinic. Neurourol Urodyn 2020; 40:509-514. [PMID: 33348456 DOI: 10.1002/nau.24590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022]
Abstract
AIMS Nocturia has been increasingly recognized as a potential manifestation of cardiovascular disease. However, the relationship between nocturia and electrocardiographic (ECG) abnormalities has not been studied. This study aims to characterize the diagnostic utility of nocturia in identifying left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc on ECG. METHODS Retrospective analysis of nocturnal voiding frequency and contemporaneous ECG data from consecutive patients evaluated at a university-based outpatient cardiology clinic. Three sets of three incremental binary multiple logistic regression models controlling for (1) age, (2) sex and race, and (3) body mass index, hypertension, diabetes mellitus, and diuretic utilization were performed to determine whether nocturia was predictive of LVH, LAE, and prolonged QTc. RESULTS Included patients (n = 143, 77.6% nocturia) were predominantly African-American (89.5%), female (74.1%), and obese (61.5%), of whom 44.1%, 41.3%, and 27.3% had LVH, LAE, and prolonged QTc, respectively. Older age, African-American race, obesity, hypertension, diuretic use, LVH, and LAE were significantly associated with nocturia on univariate analysis. No significant differences were observed in the strength of associations between nocturia and LVH, LAE, or QTc prolongation based on age. Nocturia independently predicted LVH in Models I-III (odds ratios [ORs], 2.99-3.20; relative risks [RRs], 1.18 for all, p ≤ .046) and LAE in Models I-III (ORs, 4.24-4.72; RRs, 1.21 for all, p ≤ .015). No significant associations were observed between nocturia and prolonged QTc. CONCLUSIONS Nocturia may be a risk marker for underlying structural cardiac abnormalities.
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Affiliation(s)
- Pakinam Mekki
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lily Lee
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Christina W Agudelo
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Fred Gong
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Christopher D George
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kyle P Michelson
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Zhan D Wu
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Roger R Dmochowski
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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Monaghan TF, Wagg AS, Bliwise DL, Agudelo CW, Michelson KP, Rahman SN, Epstein MR, Haddad R, Everaert K, Lazar JM, Weiss JP. Correction to: Association between nocturia and frailty among elderly males in a veterans administration population. Aging Clin Exp Res 2020; 32:2111. [PMID: 32077072 DOI: 10.1007/s40520-019-01456-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the original publication of the article, the author's name Jeffrey P. Weiss was misspelled as "Jeffry P. Weiss".
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina W Agudelo
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Kyle P Michelson
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Syed N Rahman
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew R Epstein
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.,Department of Urology, Temple University Hospital, Philadelphia, PA, USA
| | - Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Sorbonne Université, UPMC Univ Paris 06, AP-HP GRC 01, Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Rééducation Neurologique, AP-HP, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
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Monaghan TF, Wagg AS, Bliwise DL, Agudelo CW, Michelson KP, Rahman SN, Epstein MR, Haddad R, Everaert K, Lazar JM, Weiss JP. Association between nocturia and frailty among elderly males in a veterans administration population. Aging Clin Exp Res 2020; 32:1993-2000. [PMID: 31760609 DOI: 10.1007/s40520-019-01416-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The relationship between frailty and nocturnal voiding is poorly understood. AIM To characterize the association between frailty, as defined by a frailty index (FI) based upon the Canadian Study of Health and Aging (CSHA) criteria, and nocturia, defined by measures of nocturnal urine production. METHODS Real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic. Males ≥ 65 years with ≥ 2 nocturnal voids were included. A modified FI was calculated from the LUTS database, which captured 39 variables from the original CSHA FI. Patients were divided into 3 groups by modified FI: low (≤ 0.077) (n = 59), intermediate (> 0.077 and < 0.179) (n = 58), and high (≥ 0.179) (n = 41). Diary parameters were compared using the Kruskal-Wallis test and pairwise comparisons with the Wilcoxon rank-sum test and Bonferroni adjustment. RESULTS The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The presence of comorbid diabetes mellitus did not explain this effect. CONCLUSION Elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production. Future research on the mechanistic relationship between urine production and functional impairment is warranted.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina W Agudelo
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Kyle P Michelson
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Syed N Rahman
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew R Epstein
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Temple University Hospital, Philadelphia, PA, USA
| | - Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Sorbonne Université, UPMC Univ Paris 06, AP-HP GRC 01, Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Rééducation Neurologique, AP-HP, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
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Emeruwa CJ, Epstein MR, Michelson KP, Monaghan TF, Weiss JP. Prevalence of the nocturnal polyuria syndrome in men. Neurourol Urodyn 2020; 39:1732-1736. [PMID: 32501556 DOI: 10.1002/nau.24403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 11/11/2022]
Abstract
AIMS Nocturnal polyuria (NP) is caused by a wide array of factors, including genitourinary and systemic comorbidities, modifiable behavior, and pharmaceuticals. When an identifying factor is absent, NP may be purely a symptom of the nocturnal polyuria syndrome (NPS) and secondary to blunting of normal arginine vasopressin action within the circadian rhythm. The purpose of this study is to determine the prevalence of NPS in male patients attending a Veterans Affairs outpatient urology clinic. METHODS Retrospective database analysis was performed of voiding diaries from men who had established care for lower urinary tract symptoms from 2007 to 2018. Patients were excluded if they reported fewer than two nocturnal voids on voiding diary analysis or had comorbidity associated with NP. Distinct cutoffs were separately employed to identify NP: nocturnal polyuria index (NPi; calculated as nocturnal urine volume divided by 24-hour urine volume) greater than 0.33; and nocturnal urine production (NUP) greater than 90 mL/h. RESULTS A total of 283 completed voiding diaries were evaluated and 202 patients had ≥2 nocturnal voids. After exclusions, at NPi greater than 33, the floor and ceiling NPS prevalence values were 21% and 41%, respectively. At NUP greater than 90 mL/h, the floor and ceiling NPS prevalence values were 17% and 32%, respectively. CONCLUSIONS The prevalence of NPS in patients with nocturia in the present study lies between 17% and 41%. NPS constitutes a clinically relevant subgroup of nocturia among male patients in the Veterans Affairs outpatient urology setting.
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Affiliation(s)
- Curran J Emeruwa
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Matthew R Epstein
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Kyle P Michelson
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
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Monaghan TF, Agudelo CW, Rahman SN, Michelson KP, Lazar JM, Everaert K, Weiss JP, Bliwise DL. 1012 Urologic Features Related to the First Uninterrupted Sleep Period (FUSP) in Nocturia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In nocturia, longer FUSP (time to first void) correlates with better quality sleep (Bliwise et al, JCSM 2015;11:53-5) and, with treatment, longer FUSP is associated with decreased nightly voids (Epstein et al, Neurourol Urodyn 2018;37:186-91). We examined urologic correlates of FUSP in an outpatient nocturia population without comorbidities (CHF, OSA, ESRD, diuretics).
Methods
Participants (n=119; men) kept a home flow/volume diary, tracking clock time and quantity of each urination across a 24-hr period. FUSP was defined as time between going to bed and time of first void. We analyzed the urine volume at first nocturnal void (FNVV) (i.e., at end of FUSP). We also analyzed all nighttime volumes and divided by reported hours of sleep to impute nocturnal urine production (NUP) (in ml/hr, classified as high [>90 ml/hr] [n=49] vs low [<90 ml/hr] [n=60])—a measure correlated with number of nocturia episodes (van Doorn et al, J Urol 2014;191:1034-9). Nocturnal maximal voided volume (NMVV) at any single nocturnal void defined maximal functional nocturnal bladder capacity. Data were analyzed non-parametrically.
Results
For 53 of 119 patients, FNVV was identical to NMVV. This was more likely in patients with NUP >90 ml/hr vs <90 ml/hr (59% vs 40%, p=.046). High (vs low) NUP rates were also associated with higher FNVV (300 [225-420] vs 135 [100-200] ml, p<.001), as well as higher number of voids (3 vs. 2, p=.03).
Conclusion
For nearly half of these nocturia patients, the volume at first void occurred at their maximal nocturnal volume. In nocturia, higher FNVV also reflects greater overall nocturnal volume of urine produced, and excess urine volume (as opposed to insufficient bladder capacity) likely plays a central role in the pathogenesis of nocturia in these patients. The extent to which these higher initial volumes represent free-water vs solute-driven clearance is currently under investigation.
Support
N/A
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Affiliation(s)
- T F Monaghan
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - C W Agudelo
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - S N Rahman
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - K P Michelson
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - J M Lazar
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - K Everaert
- Ghent University Hospital, Ghent, BELGIUM
| | - J P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - D L Bliwise
- Emory University School of Medicine, Atlanta, GA
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Monaghan TF, Wagg AS, Agudelo CW, Rahman SN, Michelson KP, Epstein MR, Everaert K, Lazar JM, Weiss JP, Bliwise DL. 0822 Frail Older Men With Nocturia are Disproportionately Affected by Excess Nocturnal Urine Production. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Nocturia is a risk factor for falls and hip fractures in older adults. We determined whether the Frailty Index (FI), incorporating comorbidities, functional performance, and physical signs, was associated with nocturia frequency and/or overnight urine production.
Methods
We examined nightly (24-hour) voiding diaries (men ≥65 years) in an outpatient urologic clinic demonstrating ≥2 nocturnal voids (n=158). FI calculations followed Rockwood (CMAJ 2005;173:489-95). A total of 39 conditions were assessed. Three FI groups were established: Low (≤0.077) (n=59), Intermediate (>0.077 and <0.179) (n=58), and High (≥0.179) (n=41). We compared number of nocturnal voids (NV), nocturnal urine volume (NUV) (in mL), and 24-hr total urine volume (24-hr TUV) (in mL) across groups.
Results
NV did not differ by group (p=0.333) (median for all groups=3). However, NUV (916 [671-1419] vs. 690 [505-942] vs. 630 [500-1050] mL) differentiated the High, Medium and Low FI groups (p<0.001 via Kruskal-Wallis with Bonferroni pairwise adjustments), respectively. Similarly, 24-hr TUV differentiated the 3 groups (2200 [1800-2550] vs. 1620 [1259-2119] vs. 1650 [1390-2517] mL, p=0.005). Differences in NUV remained significant (p=0.006) after eliminating Diabetes Mellitus cases (n=44). However, differences did not persist for 24-hr TUV (p=0.180).
Conclusion
Higher NUV, but not 24-hr TUV, was a robust correlate of frailty in these older men. Accounting for diabetes did not diminish the effect. Although undiagnosed sleep apnea remains a possible cause, recent chronobiologic data (Monaghan et al, Age Aging, 2020, in press) suggest that nocturia in the aged is characterized by excess free water clearance early in the sleep period. This argues against solute-driven urine production (as might be expected in sleep apnea) in accounting for the effect. Nocturia may represent a conspicuous and important change in circadian rhythm of urine production occurring in old age.
Support
N/A
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Affiliation(s)
- T F Monaghan
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - A S Wagg
- University of Alberta, Edmonton, AB, CANADA
| | - C W Agudelo
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - S N Rahman
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - K P Michelson
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - M R Epstein
- Temple University Hospital, Philadelphia, PA
| | - K Everaert
- Ghent University Hospital, Ghent, BELGIUM
| | - J M Lazar
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - J P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - D L Bliwise
- Emory University School of Medicine, Atlanta, GA
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Monaghan TF, Michelson KP, Wu ZD, Gong F, Agudelo CW, George CD, Alwis US, Epstein MR, Mekki P, Flores VX, Bliwise DL, Everaert K, Vande Walle J, Weiss JP, Lazar JM. Sodium restriction improves nocturia in patients at a cardiology clinic. J Clin Hypertens (Greenwich) 2020; 22:633-638. [PMID: 32049435 PMCID: PMC8029872 DOI: 10.1111/jch.13829] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 10/15/2023]
Abstract
This study aims to determine whether dietary sodium restriction counseling decreases nocturnal voiding frequency in cardiology patients with concomitant nocturia. Patients who had established care at a cardiology clinic from 2015 to 2018 reporting ≥1 average nocturnal void(s) underwent a comprehensive sodium intake interview by their cardiologist, who provided them with individualized strategies for dietary sodium reduction and assessed adherence at follow-up. Average nocturnal voiding frequency and dietary adherence were documented in the medical record. A nocturia database was compiled for retrospective analysis. A total of 74 patients were included. Patients considered to be adherent with dietary sodium restriction at follow-up (n = 56) demonstrated a decrease in median nocturia frequency (2.5 [2.3-3.0] vs 1.0 [1.0-2.0] voids, P < .001). Among nonadherent patients (n = 18), median nocturia frequency did not significantly change from baseline to follow-up (2.0 [1.5-3.8] vs 2.0 [1.5-4.8] voids, P = .423). Median changes were significantly different between the adherent and nonadherent groups (P < .001). Examination of second follow-up available from 37 patients showed a continued effect. In conclusion, adherence with dietary sodium counseling appears to improve nocturia. Accordingly, dietary modification may represent an important adjunct therapy to lifestyle and pharmacologic interventions for decreasing nocturia frequency. Reduction in nocturnal voiding frequency may also reflect an additional benefit of dietary sodium restriction in accordance with best practice standards for cardiovascular disease.
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Affiliation(s)
- Thomas F. Monaghan
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Kyle P. Michelson
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Zhan D. Wu
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Fred Gong
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Christina W. Agudelo
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Christopher D. George
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | | | - Matthew R. Epstein
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Pakinam Mekki
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Viktor X. Flores
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Donald L. Bliwise
- Department of NeurologyEmory University School of MedicineAtlantaGAUSA
| | - Karel Everaert
- Department of UrologyGhent University HospitalGhentBelgium
| | - Johan Vande Walle
- Department of Pediatric NephrologyGhent University HospitalGhentBelgium
| | - Jeffrey P. Weiss
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Jason M. Lazar
- Division of Cardiovascular MedicineDepartment of MedicineSUNY Downstate Health Sciences UniversityBrooklynNYUSA
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Monaghan TF, Gong F, Vaysblat M, George CD, Michelson KP, Wu ZD, Agudelo CW, Bliwise DL, Everaert K, Weiss JP, Sadovsky R, Wein AJ, Lazar JM. Nocturia: a marker of furosemide treatment response? An exploratory study. BJU Int 2020; 125:636-637. [DOI: 10.1111/bju.15017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas F. Monaghan
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Fred Gong
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Michael Vaysblat
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Christopher D. George
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Kyle P. Michelson
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Zhan D. Wu
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | | | - Donald L. Bliwise
- Department of Neurology; Emory University School of Medicine; Atlanta GA USA
| | - Karel Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Jeffrey P. Weiss
- Department of Urology; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Richard Sadovsky
- Department of Family Medicine; State University of New York Downstate Health Sciences University; Brooklyn NY USA
| | - Alan J. Wein
- Division of Urology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - Jason M. Lazar
- Department of Medicine; Division of Cardiovascular Medicine; SUNY Downstate Health Sciences University; Brooklyn NY USA
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Monaghan TF, Epstein MR, Bliwise DL, Michelson KP, Wu ZD, Lazar JM, Everaert K, Kabarriti AE, Holmes A, Wein AJ, Weiss JP. Time of peak nocturnal diuresis rate between men with secondary nocturnal polyuria versus nocturnal polyuria syndrome. Neurourol Urodyn 2020; 39:785-792. [DOI: 10.1002/nau.24283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/09/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas F. Monaghan
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
- Department of Urology Veterans Affairs New York Harbor Healthcare System Brooklyn New York
| | - Matthew R. Epstein
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
- Department of Urology Veterans Affairs New York Harbor Healthcare System Brooklyn New York
| | - Donald L. Bliwise
- Department of Neurology Emory University School of Medicine Atlanta Georgia
| | - Kyle P. Michelson
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
- Department of Urology Veterans Affairs New York Harbor Healthcare System Brooklyn New York
| | - Zhan D. Wu
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
- Department of Urology Veterans Affairs New York Harbor Healthcare System Brooklyn New York
| | - Jason M. Lazar
- Division of Cardiovascular Medicine Department of Medicine SUNY Downstate Health Sciences University Brooklyn New York
| | - Karel Everaert
- Department of Urology Ghent University Hospital Ghent Belgium
| | - Abdo E. Kabarriti
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
| | - Arturo Holmes
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
- Department of Urology Veterans Affairs New York Harbor Healthcare System Brooklyn New York
| | - Alan J. Wein
- Division of Urology Perelman School of Medicine, University of Pennsylvania Health System Philadelphia Pennsylvania
| | - Jeffrey P. Weiss
- Department of Urology SUNY Downstate Health Sciences University Brooklyn New York
- Department of Urology Veterans Affairs New York Harbor Healthcare System Brooklyn New York
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Monaghan TF, Rahman SN, Bliwise DL, Michelson KP, Agudelo CW, Miller CD, Weinstein CS, Olesen TK, Lazar JM, Everaert K, Verbalis JG, Weiss JP. Identifying men with global polyuria on a nocturnal-only voiding diary. Neurourol Urodyn 2019; 39:347-352. [PMID: 31692071 DOI: 10.1002/nau.24210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/20/2019] [Indexed: 11/05/2022]
Abstract
AIMS Nocturnal polyuria (NP) and global polyuria (GP) are not mutually exclusive. However, by rate, the common criteria for GP (40 mL/kg/24 hours [117 mL/kg/hour in a 70-kg individual] or 3000 mL/24 hours [125 mL/h]) are more stringent than those for NP (90 mL/hour during the sleep period or NP index [NPi; nocturnal volume/24-hour volume] > 0.33 [no minimum rate]). It remains unclear whether total nocturnal urine volume (NUV) may reliably delineate between NP patients with and without comorbid GP. METHODS A clinical database of men with lower urinary tract symptoms was searched for voiding diaries completed by patients reporting greater than or equal to 1 nocturnal void(s). Four separate analyses were performed using all combinations of the two NP and two GP criteria listed above. For each analysis, patients were included if they met the criteria for NP, and then stratified by presence or absence of GP (ie, NP + GP vs isolated NP). RESULTS Median NUV was greater among patients with NP + GP for all criteria combinations. Sensitivities greater than or equal to 80%/90%/100% for NP + GP were observed at 1275/1230/1085 mL for {NPi > 0.33 + 24-hour volume > 3000 mL}; 1075/1035/1035 mL for {NPi > 0.33 + 24-hour volume > 40 mL/kg}; 900/745/630 mL for {NUP > 90 mL/hour + 24-hour volume > 3000 mL}; and 1074/1035/990 mL for {NUP > 90 mL/hour + 24-hour volume > 40 mL/kg}. CONCLUSIONS An inordinate NUV among men with NP is fairly sensitive for comorbid GP. In the appropriate clinical setting, nocturnal-only diaries may suffice in the evaluation and follow-up of patients with NP, so long as outlying nocturnal volumes prompt a 24-hour diary/urine collection.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Syed N Rahman
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Kyle P Michelson
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Christina W Agudelo
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Connelly D Miller
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Corey S Weinstein
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Tine K Olesen
- Department of Urogynaecology, Ghent University Hospital, Ghent, Belgium
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Joseph G Verbalis
- Department of Medicine, Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, District of Columbia
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York
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Epstein MR, Monaghan TF, Khusid JA, Suss NR, Agudelo CW, Michelson KP, Wu ZD, Gong F, Weiss JP. Comparison of nocturia etiology in black and white male patients. Can J Urol 2019; 26:9769-9773. [PMID: 31180307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Much of what is known about the etiology of nocturia (i.e., nocturnal polyuria [NP], small bladder capacity [SBC], etc.) at the population level stems from the Krimpen study, which enrolled aging males from a homogenous municipality in the Netherlands. Given the higher prevalence of benign prostatic hyperplasia and overactive bladder in black versus white males in population research, we aim to test the hypothesis that black males seeking treatment for lower urinary tract symptoms (LUTS) are more likely to have nocturia owing to SBC. MATERIALS AND METHODS We retrospectively analyzed 24 hour frequency-volume charts (FVCs) completed by males seeking treatment for LUTS at a Veterans Affairs urology clinic from 2008-2016. Patients were included if they were ≥ 18 years, identified as either Caucasian or African American, and had a complete baseline FVC showing ≥ 1 nocturnal void. Patients were stratified by race and classified as having nocturia owing to SBC (defined by a maximum voided volume < 200 mL or a nocturnal bladder capacity index > 1.3); NP (defined by a nocturnal polyuria index > 0.33); 'mixed' (SBC + NP); or 'other' (neither SBC nor NP). RESULTS Between white and black patients, 28 (24%) versus 28 (26%) had NP, 32 (27%) versus 33 (30%) had SBC, and 35 (30%) versus 30 (28%) had mixed nocturia. Overall, there was no difference in distribution of underlying etiology by race (p = 0.51). CONCLUSIONS Our results demonstrate no difference in the etiology of nocturia between black and white males. Accordingly, race should not play a role in the evaluation of patients seeking treatment for nocturia.
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Affiliation(s)
- Matthew R Epstein
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York, USA
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Monaghan TF, Bliwise DL, Suss NR, Epstein MR, Wu ZD, Michelson KP, Agudelo CW, Robins DJ, Wagg A, Weiss JP. Overnight Urge Perception in Nocturia Is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Population. J Clin Sleep Med 2019; 15:615-621. [PMID: 30952224 DOI: 10.5664/jcsm.7726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/09/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The goal of this study was to compare the urge perception associated with nocturnal voiding at the time of voiding in individuals with and without depression, posttraumatic stress disorder (PTSD), or anxiety diagnoses to test the hypothesis that patients with such diagnoses are more likely to experience insomnia-driven convenience voiding during the sleep period. METHODS A database of voiding diaries with urge perception grades (UPGs) from 429 adult males seeking treatment for nocturia at a Veterans Affairs-based urology clinic was analyzed. The UPG categorizes perception for urinating from 0 (out of convenience) to 4 (desperate urge). Diaries completed by males age 18 years and older showing ≥ 2 nocturnal voids were included. Those included (n = 178) were divided into two cohorts based on the presence (n = 62) or absence (n = 116) of one or more previously established mental health diagnoses (depression, PTSD, or anxiety). The chi-square test was used to determine significance between groups. RESULTS Patients with a mental health diagnosis were more likely to report convenience voiding compared to those without depression, PTSD, or anxiety (14.5% versus 0.8%, P < .01). However, most voids in both groups were associated with the perception of urinary urgency. There were no differences in urinary volumes or hourly rates of urine production between the groups. CONCLUSIONS A relatively small subset of urology patients experience nocturnal voiding because they are awake for reasons other than the urge to void. Mental health factors had a substantial, albeit minimal, effect. Most nocturia reflects urgency to urinate rather than voiding by convenience.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Nicholas R Suss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Matthew R Epstein
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Zhan D Wu
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Kyle P Michelson
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | | | - Dennis J Robins
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
| | - Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, Edmonton, Canada
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
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