The Impact of Nocturia on Health Status and Quality of Life in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (LUTS/BPH)

Abstract

Nocturia (nocturnal voiding) is a common condition in the older population and its prevalence increases with age. Although the aetiology of nocturia may be multifactorial, a main cause in older men is benign prostatic hyperplasia/bladder outlet obstruction (BPH/BOO). Nocturia is experienced as one of the most bothersome symptoms of lower urinary tract symptoms (LUTS) suggestive of BPH/BOO by the patient and interferes considerably with the patient's ability to perform daily activities and hence his quality of life (QoL). Nocturnal micturition in particular is associated with a considerable morbidity resulting from sleep disruption. Contrary to earlier beliefs, recent studies indicate that lack of sleep may seriously impair health. Poor sleep is associated with daytime fatigue, decreased cognitive performance, loss of energy/vitality, depression, and increased susceptibility to disease. Not only the patient but also his spouse may suffer sleep disruption and associated morbidity. In nocturics with an active professional and social life impaired sleep leads to a decline in work performance, decreased levels of activity and increased rates of sick leave. In addition, waking up at night and finding one's way to the bathroom for voiding represents an important risk factor for falls and fractures in the older population. Falls in the elderly contribute to a declined functional performance and the loss of independence. Nocturia is also a predisposing factor for nursing home admission and has been associated with increased mortality. Current initial treatment for the relief of LUTS/BPH symptoms including nocturia consists mainly of α 1-adrenoceptor (AR) antagonists, 5α-reductase inhibitors, or a combination of both. Although these agents relieve urinary symptoms, few studies have specifically addressed their impact on nocturia. However, it is well known that orthostatic hypotension, an adverse effect of the less selective α 1-AR antagonists, contributes to imbalance. As such, the risk for falls and fractures may increase in LUTS/BPH patients who have to get up at night to void. Hence, LUTS/BPH treatment should aim to interfere as minimally as possible with blood pressure regulation.