Factors related to nocturia-specific quality of life in renal transplantation patients

OBJECTIVES

Patients following renal transplantation (RTX) may experience nocturia exacerbation due to polyuria and reduced bladder capacity, thereby impacting the specific quality of life (QOL) associated with nocturia. The present study aims to investigate factors associated with the deterioration of nocturia-specific QOL in RTX patients.

METHODS

The study cohort comprised 59 consecutive patients who had undergone successful RTX. Nocturia-related QOL questionnaires (N-QOL) were employed to evaluate the specific QOL related to nocturia. The Bother/Concern and Sleep/Energy domains of the N-QOL were also assessed. The primary outcome measure was to explore factors related to the aggravation of nocturia-specific QOL in patients post-RTX.

RESULTS

The mean nocturia frequency post-RTX was 1.3 ± 1.0. Univariate and multivariate analyses revealed a significant reduction in the Bother/Concern domain score associated with increased nocturia (p = .042). Aging significantly decreased the total N-QOL score and the Sleep/Energy domain score (p = .001 and .0002, respectively). Prolonged duration after RTX significantly reduced the scores of both the Sleep/Energy domain and the Bother/Concern domain (p = .018 and .037, respectively). However, the duration of dialysis prior to RTX was not significantly associated with the total score or subdomains of N-QOL.

CONCLUSIONS

Nocturia-specific QOL affected not only the nocturia itself, but also aging and the prolonged duration after RTX. Thus, comprehensive approaches to the RTX patients were needed to improve the Nocturia-specific QOL in RTX patients.

Overactive bladder: not just a normal part of getting older

Overactive bladder (OAB) is a common yet under-reported condition affecting both men and women. Prevalence rises with age, but OAB can affect people of any age. It is associated with increased physical and mental health problems and may lead to social isolation and escalating care needs. It is a clinical diagnosis with symptoms of urgency, with or without urge incontinence and usually with urinary frequency and nocturia. Management includes conservative, medical and surgical treatments, which can significantly improve quality of life. This review aims to raise awareness of this under-reported condition and to empower health professionals to open discussions on bladder health with all those in their care.

Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation

BACKGROUND

We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder.

METHODS

A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses.

RESULTS

A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = -0.65, 95% confidence interval [CI]: -1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: -0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: -0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = -0.14, 95% CI: -0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence quality of life scores (P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group.

CONCLUSION

Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.

Factors involved in sleep efficiency: a population-based study of community-dwelling elderly persons

STUDY OBJECTIVES

Research indicates that sleep efficiency below 80% substantially increases mortality risk in elderly persons. The aim of this study was to identify factors that would best predict poor sleep efficiency in the elderly, and to determine whether associations between these factors and sleep efficiency were similar for men and women and for younger and older elderly persons.

METHODS

A total of 2468 individuals aged 65-96 years (40.7% men) participated. They were recruited via random generation of telephone numbers according to a geographic sampling strategy. The participants agreed to have health professionals visit their home and to answer structured interview questions. Sleep efficiency was calculated based on interview responses. Descriptive statistics and logistic regressions were conducted.

RESULTS

The factors most strongly associated with sleep efficiency below 80% were pain, nocturia, sleep medication use, and awakening from bad dreams. Some factors varied by sex: women aged 75 years and older or who had an anxiety disorder were more likely to have sleep efficiency below 80%, whereas being single or having painful illness raised the likelihood for men only. Except for sex, all the factors that showed associations with sleep efficiency affected younger and older elderly persons similarly.

CONCLUSIONS

Poor sleep efficiency is prevalent among elderly persons. The results shed new light on factors associated with poor sleep efficiency, highlighting the presence of sex differences and that certain factors make no significant contribution, such as typically proscribed sleep hygiene behaviors, mood disorders, and illness in general.

Nocturia is more bothersome than daytime LUTS: Results from an Observational, Real-life Practice Database including 8659 European and American LUTS patients

PURPOSE

Lower urinary tract symptoms (LUTS) encompass several diagnoses, including overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Nocturia is a standalone symptom, but also included in OAB and BPH. Current discussion addresses whether the overlap of the diagnoses is too broad, leading to misdiagnosis. This study explored the differences in level, causes and consequences for patients with a diagnosis of daytime LUTS compared with a diagnosis of nocturia, and discussed whether people are being treated for the symptoms that truly bother them the most.

PATIENTS AND METHODS

Data were drawn from a survey of physicians and patients in France, Germany, Spain, UK and USA. Physicians filled out patient record forms (PRFs) for patients with LUTS diagnosis. The patients completed the patient self-completion form (PSC). Three PRO questionnaires were included; the OAB-q SF, NI-Diary and WPAI. Patients were grouped based on the diagnoses assigned to them by their physicians in a real-life setting.

RESULTS

Eight thousand seven hundred and thirty eight patients had a LUTS diagnosis and 5335 completed a PSC. Patients diagnosed with night-time symptoms were significantly more bothered by their LUTS than only daytime LUTS patients (all questionnaires P < .0001). Patients with nocturia reported being tired "always" or "usually" more often than patients with daytime problems only (P < .0001). Only 13% of patients with nocturia had an initial sleep period of more than 2-3 hours.

CONCLUSION

In this population of real-life patients, those with a diagnosis of nocturia reported significantly higher impact on their quality of life than patients with a diagnosis of daytime LUTS only. The underlying causes of bother were related to sleep problems. It is essential that nocturia is understood, treated and monitored as a distinct problem from OAB and BPH, to ensure that patients are treated for their main symptom.

Patients' Lived Experiences of Nocturia: A Qualitative Study of the Evening, the Night, and the Next Day

BACKGROUND

Nocturia, waking to urinate two or more times during the night, is a chronic condition associated with significant patient burden due to sleep disruption. This study aimed to explore the lived experiences of patients with nocturia in terms of the disruption to their lives during the night and day.

METHODS

Adult patients in the US diagnosed with nocturia were recruited for face-to-face qualitative interviews. Thematic analysis of patients' narratives, taking a phenomenological interpretative approach, summarised their experiences throughout the night and day, including any apparent contrasts between patients.

RESULTS

Twenty patients (10 male, 10 female) aged between 39 and 80 years, averaging three night-time voids, were interviewed. Analysis revealed that nocturia has a substantial impact on sleep quality and quantity, with the frequency of night-time voids a key driver of this. In addition to night-time phenomena, patients faced various difficulties the next day, including day-time tiredness, lack of energy and concerns related to emotional wellbeing, social functioning and cognitive functioning. All of these limited patients' capacity to work, perform daily activities or fulfil role responsibilities. Patients' lifestyles influenced experience, where younger patients in employment more readily emphasised the day-time physical and psychosocial burdens. Patients employed coping behaviours in an attempt to lessen the severity of nocturia and its impact, which were both physician-led and self-taught.

CONCLUSIONS

While the symptom of nocturia only occurs during the night, the impact is longer lasting, affecting functioning and wellbeing throughout the following day. Patients' circumstances can affect the extent of their burden; recognising this can improve effective delivery of patient-centred care.

Daily use of sildenafil 50mg at night effectively ameliorates nocturia in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: an exploratory multicenter, double-blind, randomized, placebo-controlled study

PURPOSE

To compare the efficacy and safety of sildenafil 25 mg qd, 25 mg bid or 50 mg qd - on treating lower urinary tract symptoms with benign prostatic hyperplasia (LUTS/BPH).

MATERIALS AND METHODS

Men aged > 45 years with LUTS/BPH were randomly assigned to receive sildenafil 25 mg qd (n = 42), bid (n = 41), 50 mg qd (n = 38) or placebo (n = 41) for 8 weeks. Changes from baseline in International Prostate Symptom Score (I-PSS), maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR) were assessed at week 4 and week 8.

RESULTS

Sildenafil 25 mg qd (-7.3 ± 5.8) and 25 mg bid (-7.0 ± 5.7) exhibited significant improvements of I-PSS compared to placebo (-5.2 ± 6.4) (p = 0.020, 0.025, respectively). In particular, voiding domain was more affected than storage domain. Only sildenafil 50 mg qd improved nocturia significantly (versus placebo, p = 0.027). Quality of life score was improved in all treatment groups. Q_max and PVR did not change significantly in all groups. All regimens were well tolerated.

CONCLUSIONS

Sildenafil 25 mg qd, 25 mg bid and 50 mg qd are safe and effective to improve LUTS/BPH in long term, along with coexisting ED. In particular, nocturia is most well-controlled by 50 mg qd.

Assessing the impact of nocturia on health-related quality-of-life and utility: results of an observational survey in adults

BACKGROUND AND AIM

The impact of nocturia (getting up at night to void) on health-related quality-of-life (HRQoL) is often under-estimated. This study investigated the relative burden in terms of HRQoL and utilities of nocturia in a real-world setting.

METHODS

Patient data were collected from two surveys: a nocturia-specific, cross-sectional survey of physicians and their patients (DSP), and a general UK population health survey (HSFE). Utilities (EQ-5D-5L), productivity (Work Productivity and Activity Index), and the impact of nocturia symptoms (Nocturia Impact Diary and Overactive Bladder Questionnaires) were assessed against the number of voids. A robust linear regression model with propensity score weights was used to control for confounding factors in estimating utilities.

RESULTS

Physician-recorded data were available from 8,738 patients across the US, Germany, Spain, France, and the UK; of these, 5,335 (61%) included patient-reported outcomes. In total, 6,302 controls were drawn from the two surveys and compared to 1,104 nocturia patients. Deterioration of HRQoL was associated with increasing number of night-time voids (p < 0.0001). In particular, significant differences were observed between 0-1 and ≥2 voids (p < 0.001). The regression model demonstrated that nocturia (≥2 per night) is associated with a modest but significant deterioration in utility of 0.0134 (p < 0.05).

LIMITATIONS

The cause of nocturia is multifactorial and the mostly elderly patients may have several concomitant diseases. The authors tried to adjust for the most common ones, but there may be diseases or unknown relationships not included.

CONCLUSIONS

Nocturia negatively affected HRQoL and patient utility. A clear effect is seen already at two voids per night. Every effort should, therefore, be made to reduce nocturia below the bother threshold of two voids per night.

Comprehensive Health-Related Quality of Life is Influenced by Nocturia and Sleep Disturbance: Investigation Based on the SF-8

We investigated the influence of nocturia and sleep disturbance on health-related quality of life(HRQOL) using the Medical Outcomes Study 8-item Short Form Health Survey (SF-8) in patients with nocturia. We also assessed the effect of therapeutic intervention by means of an anticholinergic agent on the results of the SF-8. One hundred and eighty-four patients who voided at least once per night were surveyed using the SF-8, Overactive Bladder Symptom Score (OABSS), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). These parameters were also evaluated before and after 12 weeks of imidafenacin treatment in 51 patients with OAB accompanied by nocturia. The SF-8 physical component summary score (PCS) showed a significant decrease as nighttime voiding frequency increased. The mental health component summary score was 47.1 and 47.6 (which were lower than the standard value of 50) in the group with a nighttime frequency of once and ≥3/night, respectively. The SF-8 PCS and 6 subscales were negatively associated with nighttime voiding frequency, while the PSQI global score was positively associated with it. Imidafenacin significantly improved the OABSS, PSQI, and ESS, as well as the SF-8 score. This is the first study using the SF-8 to show that nocturia and sleep disturbance have a major influence on comprehensive HRQOL and that the SF-8 can be used to monitor HRQOL in OAB patients receiving treatment for nocturia.

The Nocturia Impact Diary: a self-reported impact measure to complement the voiding diary

BACKGROUND

Nocturia is a chronic, fluctuating disease that disrupts sleep and has a wide-ranging impact on quality of life. Valid tools to measure the patient-reported impact of nocturia are essential for evaluating the value of treatment, but the available tools are suboptimal.

OBJECTIVES

This study reports the development and validation of the Nocturia Impact Diary-an augmented form of the Nocturia Quality of Life questionnaire designed to be completed in conjunction with the widely used 3-day voiding diary.

METHODS

The process comprised three steps: Step 1: Development of a concept pool using the Nocturia Quality of Life questionnaire and data from relevant studies; Step 2: Content validity study; Step 3: Psychometric testing of construct validity, reliability, and sensitivity of the diary in a randomized, placebo-controlled study in patients with nocturia.

RESULTS

Step 1: Fourteen items and 4 domains were included in the first draft of the diary. Step 2: Twenty-three patients with nocturia participated in the cognitive debriefing study. Items were adjusted accordingly, and the content validity was high. Step 3: Fifty-six patients were randomized to desmopressin orally disintegrating tablet or placebo. The diary demonstrated high construct validity, with good sensitivity and a good fit to Rasch model, as well as high internal consistency, discriminatory ability, and acceptable sensitivity to change. Results indicated that the diary was unidimensional.

CONCLUSIONS

The Nocturia Impact Diary is a convenient, validated patient-reported outcome measure. It should be used in conjunction with a voiding diary to capture the real-life consequences of nocturia and its treatment.

Patient-reported outcomes and different approaches to urinary parameters in overactive bladder: what should we measure?

Overactive bladder (OAB) is highly prevalent and associated with considerable impact on patient health-related quality of life (HRQoL). Assessment of HRQoL can reveal the burden of disease and post-intervention improvement. This review aims to highlight the importance of HRQoL assessment and outline the tools available for use in clinical trials and real-world clinical practice. A number of validated measures of HRQoL specific to OAB have been developed, offering greater sensitivity and responsiveness over generic instruments. These condition-specific, multi-dimensional and single-item global questionnaires are particularly useful for the multiple and varied symptoms of OAB, as they reflect the patient's needs, concerns and values. Measurements for lower urinary tract symptoms, e.g. bladder diaries, are being compared with HRQoL instruments to provide greater understanding of the disease and treatment from the patient's perspective. Therapeutic interventions to improve OAB symptoms should also be evaluated for their effect on the patient's HRQoL.

Demystifying nocturia: identifying the cause and tailoring the treatment

Nocturia is a common problem with a significant impact on quality of life. The etiology of nocturia is multifactorial. Recent standardized terminology with respect to nocturia has been developed to promote more efficient communication among providers/specialists. A careful history, physical examination, and use of a voiding diary are important steps in identifying the etiology of nocturia and assist in tailoring the treatment regimen.

Men's lower urinary tract symptoms are also mental and physical sufferings for their spouses

Lower urinary tract symptoms (LUTS) in men may have an adverse effect on spouse health-related quality of life (HRQL), and these effects are probably influenced by cultural and perceptional differences. This study was conducted to explore the impact of LUTS in Korean men on their spousal HRQL in relation to symptom severities and other demographic parameters. A total of 130 spouses, whose husbands had a nocturia, frequency of greater than once per night, who shared a bed with their husbands, and accompanied husbands at consultation, were subsequently enrolled and asked to complete a structured questionnaire. Almost all spouses (98%) suffered one or more inconveniences that affected HRQL to some degree. Sleep disturbance was rated to be most inconvenient. The sleep disturbances were significantly correlated with nocturia frequency and husband co-morbidity. Husband's LUTS caused partners to feel fatigued (62%), embarrassed (79%), concerned about the possibilities of cancer (69%) and surgery (81%), sexual life deteriorated (58%), and dissatisfied, unhappy, or terrible (36%). Spouse's perception on HRQL was found to be well correlated with husband's quality of life. Men with LUTS need to understand that their LUTS is also mental and physical sufferings for their spouses.

Pediatric voiding dysfunction: a case study

A 14-year-old male was evaluated and treated for frequent urination associated with straining to void, a sensation of incomplete emptying, and nocturia. Treatment and outcomes are presented in this article.

Predictors of Nocturia Quality of Life Before and Shortly After Prostatectomy

OBJECTIVES

To evaluate the predictors of nocturia-related quality of life and to assess the early effect of prostatectomy on these parameters in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction.

METHODS

The study group included 56 consecutive patients scheduled for prostatectomy to treat medical treatment-refractory lower urinary tract symptoms. Nocturia severity was assessed preoperatively and 2 to 3 months after prostatectomy by the number of nocturia events, time from falling sleep to first awakening to void (hours of undisturbed sleep [HUS]), longest sleep interval between voids, and score on the nocturia quality-of-life (N-QOL) questionnaire (range 0 to 48).

RESULTS

The mean age of the study group was 69 +/- 9 years. The preoperative N-QOL score correlated strongly with the number of nocturia events, HUS, and longest sleep interval between voids (r = -0.69, r = 0.67, and r = 0.69, respectively, and P <0.001). Of the 56 patients, 36 (65%) underwent transurethral prostatectomy and 20 (35%) underwent open prostatectomy. Significant improvement (P <0.001) was noted in all factors after treatment. The number of nocturia events decreased from 3.4 +/- 1.2 to 2.6 +/- 0.99; the HUS increased from 1.83 +/- 0.55 to 2.74 +/- 0.64 hours; the longest sleep interval between voids increased from 2.36 +/- 0.64 to 2.91 +/- 0.6 hours; and the N-QOL score increased from 24.1 +/- 7 to 34.4 +/- 7.5. On multivariate stepwise regression analysis, the factors predicting for improvement in the N-QOL score after prostatectomy were the number of nocturia events and HUS.

CONCLUSIONS

Prostatectomy is associated with an early postoperative improvement in nocturia indexes. The increases in the interval to first void and decrease in even less than one nocturia event were associated with significant improvement in nocturia quality of life.

[Impact of nocturia on the daily life of patients with lower urinary tract symptoms due to benign prostatic hyperplasia]

Nocturia is defined as the patient's complaint of having to get up once or several times during the night to urinate, with each voiding preceded and followed by a period of sleep. The direct consequence of nocturia is impaired quality of sleep. The decreased daytime energy is responsible for depression and metabolic disorders and an indirect increase of mortality. Nocturia is a difficult problem to treat in the management of BPH. An effective treatment against nocturia can improve quality of life by acting on quality of sleep. Alpha-blockers, which control these symptoms, are a major component of treatment. However, the dosage forms available are often pharmacologically dependent on dosing conditions, and do not allow maintenance of constant blood levels of the drug. The OCAS (Oral Controlled Absorption System) form of tamsulosin allows absorption of the drug throughout gastrointestinal tract and maintenance of a constant plasma concentration over the 24-hour period.

Frequent napping is associated with excessive daytime sleepiness, depression, pain, and nocturia in older adults: findings from the National Sleep Foundation '2003 Sleep in America' Poll

OBJECTIVE

The objective of this study was to describe the prevalence and correlates of regular napping among older adults.

METHODS

The National Sleep Foundation's "2003 Sleep in America Poll," a 20-minute telephone interview that focused on the topic of "sleep and aging" (N = 1,506 adults 55-84 years of age).

RESULTS

Overall, 15% of respondents reported regular napping, ranging in prevalence from 10% among those 55-64 years of age to 25% among those 75-84 years of age. In addition to older age and a strong association with excessive daytime sleepiness, other factors that independently increased prevalence included a diagnosis of depression, bodily pain, and nocturia.

CONCLUSIONS

Regular napping is common among older adults. Longitudinal studies of napping behavior and health status are needed to establish risk factors other than excessive daytime sleepiness.

Psychometric evaluation of the medical outcomes study-sleep scale in persons with overactive bladder

BACKGROUND

The Medical Outcomes Study-Sleep Scale (MOS-SS) is a commonly used self-reported instrument for assessing key constructs of sleep quality and quantity. Even though the MOS-SS has successfully undergone previous validation studies in the general population, it has not been evaluated in patients with overactive bladder (OAB).

OBJECTIVE

The aim of this study is to evaluate the applicability of the MOS-SS to persons with a diagnosis of OAB.

METHODS

This study was a follow-up to a national nested case-control survey designed to provide estimates of the prevalence of OAB in the United States. OAB patients (N = 363) who consented to participate were mailed a postal survey to assess OAB symptoms and health-related quality of life. Analyses were then undertaken to assess the psychometric properties of the MOS-SS in this OAB sample. Psychometric evaluation of the MOS-SS included construct validity, internal consistency reliability, correlation between domains, floor/ceiling effects, and an examination of the factor structure. Results were compared with the original validation population of the MOS-SS by .

RESULTS

Internal consistency, correlations between domains, and floor/ceiling effects were generally consistent with results from the original validation study. Factor loadings of the MOS-SS items, as well as tests of construct validity, were similar between persons with OAB and individuals in the original validation population.

CONCLUSION

Psychometric evaluation conducted in this study supports the use of the MOS-SS instrument to assess sleep problems among persons with OAB.

[Self reported quality of life among patients referred to a gynaecologic ward with urinary incontinence]

INTRODUCTION

Urinary incontinence (UI) represents a frequent symptom among women of all ages. However, very few women are admitted to a hospital or clinic because of UI. The aim of the paper was to characterize women admitted to hospital because of UI in respect to symptoms and self reported quality of life.

MATERIALS AND METHODS

The study comprised all 174 women admitted to a gynaecologic ward due to lower urinary tract symptoms (LUTS) in the period from 1 November 1999 to 1 August 2001. A total of 142 women (82%) completed validated questionnaires on symptoms and quality of life and were included in this analysis.

RESULTS

The median age was 59 years. The majority (97%) had UI at least once a week. Many patients reported other LUTS--in particular nocturia (87%) and urgency (81%). Two-thirds of the women experienced UI as a major problem. The single most affected factor in terms of quality of life--mental well being--was compromised in two-thirds of the cases. Half of all women were incontinent for flatus, one-third for loose stools and one tenth for normal stools occasionally or more frequently. One out of four women experienced anal incontinence as a major problem.

CONCLUSION

The study shows that the quality of life among women referred to a gynaecologic ward because of LUTS is severely affected. Moreover, the study demonstrates a close association between UI symptoms and symptoms indicating pelvic floor malfunction, such as LUTS and anal incontinence.

Lower urinary tract symptoms and depressive symptoms in elderly men

BACKGROUND

To evaluate the impact of moderate to severe lower urinary tract symptoms (LUTS) on clinically significant depressive symptoms in elderly Chinese men aged 65 and above.

METHODS

In a large prospective cohort of 2000 Chinese men aged 65 to 92 years of age in Hong Kong, the association between moderate to severe lower urinary tract symptoms and clinically relevant depressive symptoms was studied. After excluding men with prostate or bladder cancer or surgery, 1980 subjects provided response to a structured interviewer-administered questionnaire and physical examination. A case-control analysis was performed, comparing subjects with clinically relevant depressive symptoms (cases) to those without depressive symptoms (controls).

RESULTS

In multiple analyses adjusting for all factors that were shown to be significantly associated with having clinically relevant depressive symptoms in the initial bivariate analyses, being widowed, divorced or single were associated with increased risk of having clinically relevant depressive symptoms. Having a history of cardiac disease, being a current smoker and the use of corticosteroid were also associated with increased risk. Having moderate to severe LUTS was significantly associated with increased odds of having clinically relevant depressive symptoms (OR: 2.40; CI: 1.68-3.43) even after adjustment.

LIMITATION

This study was cross-sectional and there were no clinician-based diagnostic interviews that were conducted to diagnose clinical depression and thus only clinically relevant depressive symptoms were assessed.

CONCLUSIONS

In elderly men, moderate to severe LUTS are important public health problems that are associated with increased risk of having clinically relevant depressive symptoms. These findings suggest that physicians who deal with patients with moderate to severe LUTS should consider the psychological health of their patients as this population is at risk of having clinically relevant depressive symptoms.

Perception of nocturia and medical consulting behavior among community-dwelling women

We investigated the perception of nocturia and possible explanatory factors for medical consultation among community-dwelling women. Between October 2004 and February 2005, women aged > or =40 years living in Matsu, Taiwan, who were identified as having nocturia in a previous epidemiological survey, were interviewed with a questionnaire eliciting information about nocturia-specific quality of life impact (N-QOL), perceptions of nocturia, and medical-consultation behavior. A total of 328 women completed this study. Of these, 187 (57%), 99 (30.2%), 30 (9.1%), and 12 (3.7%) reported one, two, three, and four or more nocturia episodes, respectively, per night during the past 4 weeks. Most women attributed nocturia to aging or excessive fluid intake and had a lack of medical information. Overall, only 13.1% had visited a doctor for this condition. Nocturia episodes [> or = three vs <three, odds ratio (OR) 3.8], N-QOL score (OR 2.0, per 10-point decrement), linking nocturia to a disease (OR 2.9), and medical information (OR 2.2) were independent factors associated with medical-consultation, whereas the lack of knowledge that nocturia was treatable appeared to be an important barrier to medical-consultation. Only 62.8% of the women were offered treatment upon consultation, even though nearly half of those treated reported significant improvement. A few women with nocturia have sought medical help, which appears to be affected by a compendium of factors. This study suggests that more information about nocturia should be provided to health providers and patients to identify and meet their most essential needs.

Validity and Reliability of a Questionnaire for Evaluating Nocturia, Nocturnal Enuresis and Sleep-Interruptions in an Elderly Population

OBJECTIVES

To validate a new questionnaire evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population of men and women in Denmark.

METHODS

The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) emerged from review of the literature and expert consensus. The questionnaire was a subset of a larger questionnaire comprising several domains on health status and voiding. Convergent and discriminatory validity was assessed in an unselected population of 2000 men and 2000 women 60-80 years old. To test reproducibility, 400 respondents were mailed a separate questionnaire 2 weeks apart. A subgroup of men and women with and without nocturia was used for evaluating reliability of number of nocturia episodes.

RESULTS

A total of 2825 (70.6%) filled in the questionnaire. A decrease in health status was correlated with increasing bother (range: -0.25 to -0.36, p<0.001, Spearman's r). These findings indicate acceptable convergent validity. Significant discriminatory validity was proven in separate groups of symptom severity (p<0.0001, Kruskal-Wallis test). Median kappa was 0.70 (range 0.58-0.86) indicating substantial agreement in the retest analysis. Number of nocturia episodes in questionnaires correlated with frequency volume charts (Spearman's rho 0.88; p<0.001).

CONCLUSION

These data support that the NNES-Q has a good discriminatory and convergent validity, and is reliable over time. The NNES-Q may be useful in epidemiological studies and may also have a potential in daily clinical work up in patients with nocturia and nocturnal enuresis.