Frequency Volume Research Articles

Evidence of reduced bladder capacity during nighttime in children with monosymptomatic nocturnal enuresis

Bladder capacity in children with nocturnal enuresis is assessed by maximal voided volumes (MVV) obtained through daytime frequency volume (FV) charts. Although a degree of association has been demonstrated, daytime MVV does not consistently correspond with the nocturnal bladder capacity (NBC) in monosymptomatic nocturnal enuresis (MNE). It was hypothesized that isolated reduced NBC is a common phenomenon in children with nocturnal enuresis, despite normal daytime bladder function. The aim of this study was to evaluate NBC in children with MNE and normal daytime voided volumes. Specifically, it aimed to determine the prevalence and degree of reduced NBC when using nocturnal urine production (NUP) during wet nights as a surrogate estimate of NBC. Furthermore, it aimed to investigate the relationship between NBC and desmopressin response. Data from 103 children aged 5-15 years consecutively treated for MNE in a tertiary referral centre and with normal MVV on daytime FV charts were collected for this cohort study. Home recordings were completed for 2weeks at baseline and during desmopressin dose titration. Estimated nocturnal bladder capacity (eNBC) was assessed separately each night as the total NUP causing a wet night. If NUP during a wet night was less than MVV, it was considered to be reduced eNBC during that particular night. Surprisingly, 82% (n=84) of the children with MNE and normal daytime MVV experienced at least one wet night, with NUP below the daytime MVV indicative of a reduced eNBC. For 84 patients, mean percentage of wet nights with reduced eNBC (NUP below MVV) was 49% (SD±31). A total of 11% of children with frequently reduced eNBC (>40% of wet nights with reduced eNBC) responded to desmopressin (Summary Fig.). Of the children with frequently reduced NBC, 91% experienced wet nights, with NUP <65% of expected bladder capacity (EBC). A significant proportion of children with MNE and normal MVV during the daytime frequently experienced wet nights, with a NUP well below their MVV and even <65% of EBC. This indicated that bladder reservoir dysfunction during sleep is relatively common in MNE. This abnormality was not reflected on daytime recordings, and thus nighttime data with NUP must be collected. This phenomenon may explain treatment failure to desmopressin, despite adequate antidiuretic response.

Effects of desmopressin for the treatment of nocturnal polyuria in elderly women: impact on related sleep quality.

We investigated the efficacy, safety, and impact of desmopressin on quality of sleep in treating nocturnal polyuria in elderly women. We recruited 60 women over 60 years old with lower urinary tract symptoms (LUTS), including nocturia, and with nocturnal polyuria. Nocturnal polyuria was defined as nighttime urine production exceeding 33% of the 24-hour total urine volume determined by a frequency volume (FV) chart. All patients failed to respond to treatment of their underlying disease and evening fluid restriction. Desmopressin 0.1 mg was administered orally at bedtime for 12 weeks. The participants completed a series of questionnaires on the Medical Outcomes Study (MOS) sleep scale and FV chart before and after treatment. The patient population had a mean age of 69.2 ± 9.4 years (range: 61-81). The mean duration of symptoms was 61.2 ± 45.1 months. Significant decreases were evident after desmopressin treatment in the number of nocturia episodes (3.63 ± 1.61 to 2.00 ± 1.13, p = 0.01), nocturnal urine volume (p = 0.01), nocturnal polyuria index (NPI) (p = 0.01), and nocturia index (NI) p = 0.01). Among the categories of the MOS sleep scale, sleep index (p = 0.003), sleep disturbance (p = 0.001), snoring (p = 0.028), and shortness of breath (p = 0.036) significantly changed, with a decreased number of nocturia episodes. Adverse events were mild. Desmopressin is an effective treatment for nocturnal polyuria in elderly women, where conservative treatment has failed. Sleep quality is also improved.

MP12-03 FUNCTIONAL CHANGES OF THE BLADDER IN VIVO IN MICE LACKING TRANSIENT RECEPTOR POTENTIAL MELASTAIN 2 (TRPM2) CHANNELS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Basic Research II1 Apr 2015MP12-03 FUNCTIONAL CHANGES OF THE BLADDER IN VIVO IN MICE LACKING TRANSIENT RECEPTOR POTENTIAL MELASTAIN 2 (TRPM2) CHANNELS Jun Kamei, Naoki Aizawa, Takayuki Nakagawa, Hiroki Ito, Rino Sugiyama, Yoshiyuki Akiyama, Koji Ichihara, Shuji Kaneko, Yukio Homma, and Yasuhiko Igawa Jun KameiJun Kamei More articles by this author , Naoki AizawaNaoki Aizawa More articles by this author , Takayuki NakagawaTakayuki Nakagawa More articles by this author , Hiroki ItoHiroki Ito More articles by this author , Rino SugiyamaRino Sugiyama More articles by this author , Yoshiyuki AkiyamaYoshiyuki Akiyama More articles by this author , Koji IchiharaKoji Ichihara More articles by this author , Shuji KanekoShuji Kaneko More articles by this author , Yukio HommaYukio Homma More articles by this author , and Yasuhiko IgawaYasuhiko Igawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.778AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have previously reported that there were no remarkable differences in the in vitro contractile responses of isolated detrusor smooth muscle strips to either high K+, carbachol, or electrical field stimulation between TRPM2 knock-out (KO) and wild type (WT) mice in either sexes. In this study, to further disclose the role of TPM2 channels on lower urinary tract function, we evaluated in vivo bladder function of TRPM2-KO mice by using frequency-volume (FV) measurement, and cystometry (CMG) measurements under a conscious, free-moving as well as a decerebrated, unanesthetized condition. METHODS Male and female TRPM2-KO and WT mice (10–12 weeks-old) were used. In the FV measurements, voiding behavior was monitored for 24 hours by placing the mouse in a metabolic cage that enables to measure voided urine volumes precisely. Conscious CMG measurements were performed with continuous saline-instillation (15 μl/min) in a free-moving condition at 5 days after implantation of a bladder catheter through the dome. In the CMG measurements in a decerebrated condition, mice underwent cystostomy formation and supracollicular decerebration under isoflurane-anesthesia. After recovery from the anesthesia (waiting for at least 2 hours), CMG was carried out with saline-instillation at 10 μl/min. RESULTS In the FV measurements, in females, mean voided volume and mean flow rate in TRPM2-KO mice were significantly greater than those in WT mice. In males, similar tendencies were observed, but there were no significant differences (n = 10, in each group). In the conscious CMG measurements, in females, threshold pressure, micturition pressure, intercontraction interval and mean voided volume in TRPM2-KO mice were significantly greater than those in WT mice. In contrast, in male mice, only threshold pressure in TRPM2-KO mice was significantly higher than that in WT mice (Figure 1A, n = 8 in each group). In the CMG measurements in the decerebrated condition, only threshold pressure in TRPM2-KO mice was significantly higher than that in WT mice in both sexes (Figure 1B, male TRPM2-KO n = 7, other groups n = 8). CONCLUSIONS The present study suggests that TRPM2 channels may have a role in modulating bladder mechano-sensation in mice, and also that this contribution might be more remarkable in females. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e128-e129 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jun Kamei More articles by this author Naoki Aizawa More articles by this author Takayuki Nakagawa More articles by this author Hiroki Ito More articles by this author Rino Sugiyama More articles by this author Yoshiyuki Akiyama More articles by this author Koji Ichihara More articles by this author Shuji Kaneko More articles by this author Yukio Homma More articles by this author Yasuhiko Igawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Суточный ритм мочеобразования и мочеотделения при недержании мочи у женщин

The objective of this study was to estimate the circadian rhythm of urine formation and its association with the quality of life in incontinent women. 277 patients with complaints of urinary incontinence were analysed according to a specific protocol: urodynamic testing, transperineal ureterovesical segment ultrasonography, a 3-day frequency-volume (FV) chart. Subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. The overall prevalence of nocturia was 39,7%. The nocturics were classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 30%, a low functional bladder capacity in 23,6%, a combination of both in 24,5%, polyuria in 21,8% of the cases. In 54,5% of nocturics nocturia is due to change of physiological urine formation rhythm-nocturnal polyuria. So nocturnal polyuria is a frequent symptom among urinaryincontinent patients, with a negative impact on several aspects of the quality of life.

MP1-07 THE ROLE OF SPINAL NEUROPEPTIDE Y Y1 RECEPTORS IN THE CONTROL OF MICTURITION REFLEX IN ANESTHETIZED RATS

of age-related bladder dysfunction has not been fully clarified yet. In the present study, we aimed to investigate age-related changes in the bladder function of the mouse by using precise frequency volume (FV) measurements, in vitro contractile studies and histological examination of detrusor strips. Gender differences in the age-related changes were also determined. METHODS: C57/BL6 male and female mice were divided into two groups: control (CONT: 12 months-old; n¼8 of each sex) and aged (AGED: 27-30 months-old; male: n¼6, female: n¼7). After FV measurements, in vitro organ bath studies using detrusor strips were carried out to evaluate their contractile responses to high K+ (KCl: 62 mM), carbachol (CCh: 10-3-10-8 M), and to electrical field stimulation (EFS; 2-20 Hz) in the absence and presence of atropine (10-6 M), a,b-methylene ATP (M-ATP: 10-5 M x 5 times). In separate detrusor strips, the muscle/collagen ratio was evaluated by using Masson-trichrome staining. RESULTS: In the FV measurement, there were no significant differences in mean voided volume per micturition between CONT and AGED in either sex, although AGED of both sexes had larger total voided volume per day. Female AGED showed a decreased mean uroflow rate. The contractile responses to high K+ were weaker in AGED of both sexes (Fig.). In addition, those to CCh and EFS were decreased with aging in both sexes, but when standardized by the high K+-induced contraction, the contractile responses to CCh were stronger in AGED of both sexes (Fig.), and those to EFS were stronger only in female AGED. Moreover, AGED of both sexes showed a decreased atropine-sensitive component and an increased M-ATP-sensitive component of the EFS-induced contractions. The muscle/collagen ratio in the muscle layer did not change significantly with aging in either gender. CONCLUSIONS: The current in vitro functional studies with analysis of muscle/collagen ratio indicate the intrinsic contractile property of detrusor smooth muscle in both sexes is potentially impaired with aging. The findings that the contractile responses standardized by the high K+ -induced contraction to CCh and EFS were increased in the aged bladder, suggest a compensatory mechanism for the myogenic impairment. This compensatory mechanism may make the impairment of in vivo bladder function minimal. Source of Funding: none

MP1-06 IN VIVO AND IN VITRO BLADDER DYSFUNCTION IN AGED MICE AND ITS SEX DIFFERENCES

INTRODUCTION AND OBJECTIVES: Precise pathophysiology of age-related bladder dysfunction has not been fully clarified yet. In the present study, we aimed to investigate age-related changes in the bladder function of the mouse by using precise frequency volume (FV) measurements, in vitro contractile studies and histological examination of detrusor strips. Gender differences in the age-related changes were also determined. METHODS: C57/BL6 male and female mice were divided into two groups: control (CONT: 12 months-old; n1⁄48 of each sex) and aged (AGED: 27-30 months-old; male: n1⁄46, female: n1⁄47). After FV measurements, in vitro organ bath studies using detrusor strips were carried out to evaluate their contractile responses to high K+ (KCl: 62 mM), carbachol (CCh: 10-3-10-8 M), and to electrical field stimulation (EFS; 2-20 Hz) in the absence and presence of atropine (10-6 M), a,b-methylene ATP (M-ATP: 10-5 M x 5 times). In separate detrusor strips, the muscle/collagen ratio was evaluated by using Masson-trichrome staining. RESULTS: In the FV measurement, there were no significant differences in mean voided volume per micturition between CONT and AGED in either sex, although AGED of both sexes had larger total voided volume per day. Female AGED showed a decreased mean uroflow rate. The contractile responses to high K+ were weaker in AGED of both sexes (Fig.). In addition, those to CCh and EFS were decreased with aging in both sexes, but when standardized by the high K+-induced contraction, the contractile responses to CCh were stronger in AGED of both sexes (Fig.), and those to EFS were stronger only in female AGED. Moreover, AGED of both sexes showed a decreased atropine-sensitive component and an increased M-ATP-sensitive component of the EFS-induced contractions. The muscle/collagen ratio in the muscle layer did not change significantly with aging in either gender. CONCLUSIONS: The current in vitro functional studies with analysis of muscle/collagen ratio indicate the intrinsic contractile property of detrusor smooth muscle in both sexes is potentially impaired with aging. The findings that the contractile responses standardized by the high K+ -induced contraction to CCh and EFS were increased in the aged bladder, suggest a compensatory mechanism for the myogenic impairment. This compensatory mechanism may make the impairment of in vivo bladder function minimal. Source of Funding: none

MP4-07 VOIDING BEHAVIOR AND TRANSIENT RECEPTOR POTENTIAL (TRP) CHANNEL EXPRESSIONS IN A NOVEL RAT MODEL OF CYSTITIS INDUCED BY HYDROGEN PEROXIDE (H2O2)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Basic Research II1 Apr 2014MP4-07 VOIDING BEHAVIOR AND TRANSIENT RECEPTOR POTENTIAL (TRP) CHANNEL EXPRESSIONS IN A NOVEL RAT MODEL OF CYSTITIS INDUCED BY HYDROGEN PEROXIDE (H2O2) Rino Sugiyama, Naoki Aizawa, Hiroki Ito, Yukio Homma, and Yasuhiko Igawa Rino SugiyamaRino Sugiyama More articles by this author , Naoki AizawaNaoki Aizawa More articles by this author , Hiroki ItoHiroki Ito More articles by this author , Yukio HommaYukio Homma More articles by this author , and Yasuhiko IgawaYasuhiko Igawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Oxidative stress and ischemic inflammation might take part in the pathophysiology of interstitial cystitis (IC). Several TRP channels are expressed in the bladder urothelial cells and afferent nerves innervating the bladder. Intravesical H2O2-instillation is known to induce oxidative stress and inflammation in the mouse bladder. In this study, we investigated the effect of intravesicalH2O2 on voiding behavior and mRNA expressions of TRP channels in the bladder and L6 dorsal root ganglion (DRG) of the rat. METHODS Female Wistar rats were divided into Sham and H2O2 groups. Under isoflurane-anesthesia, a catheter was inserted into the bladder through the urethra and urine was eliminated. Then, saline (Sham) or 1% H2O2 was instilled into the bladder at a rate of 6 mL/h for 30 min. Frequency volume (FV) measurements were performed repeatedly for 24 hours before and 3, 7 and 14 days after the instillation. The urinary bladder and L6 DRG were harvested when voiding behavior was most remarkably changed in the FV measurement. The harvested bladder was divided into the whole, mucosal and detrusor layers. The mRNA expressions of TRP channels (TRPV1, V2, V4, M2, M4, M8 and A1) were analyzed by RT-PCR. RESULTS In the FV measurement, the H2O2 group showed an increased voiding frequency and a decreased mean voided volume when compared with the Sham group. These changes were most remarkable at 3 and 7 days after instillation. In addition, the H2O2 group showed hematuria and reduction of food intake on the day 3 (Figure A). Therefore, we evaluated the mRNA expressions of TRP channels on the day 7. The H2O2 group had higher expressions of TRPV2 in all bladder tissues, and TRPM2 in the detrusor layer and TRPM8 in the whole and mucosal layers, and lower expressions of TRPV4 and TRPM4 in the whole and mucosal layers (Figure B). In the other TRP channels, there were no significant differences between groups. CONCLUSIONS The present H2O2-induced cystitis model showed frequent voiding with small voided volume and changes in TRP channels mRNA expressions, which mimic those observed in bladder mucosa taken from patients with IC, suggesting its possible use for the pathophysiological investigation on IC, and also possible involvement of oxidative stress in development of IC. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e44 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Rino Sugiyama More articles by this author Naoki Aizawa More articles by this author Hiroki Ito More articles by this author Yukio Homma More articles by this author Yasuhiko Igawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Influence of High Fat Diet Feeding for 20 Weeks on Lower Urinary Tract Function in Mice.

We investigated the possible changes in lower urinary tract function in mice fed a high fat diet (HFD). Male C57BL/6J mice were divided into two different feed groups: normal diet (ND) and HFD (n = 16 in each). The body weight, blood glucose level and voiding frequency/volume (FV) relations (for 24 h) were measured every 4 weeks. At 25 weeks old, blood pressure and heart rate, cystometry and isolated detrusor smooth muscle function were measured. After the experiments, serum fat level was measured. The body weight and blood glucose level of the HFD group were significantly higher than those of the ND group after 9 weeks old. In the FV measurements, the mean voided volume was not significantly different between the two groups, although voiding frequency, total voided volume and water intake volume in the HFD group were significantly lower than those in the ND group. At 25 weeks old, the mean heart rate in the HFD group was significantly higher than that in the ND group, but no significant difference in the blood pressure was observed. None of the cystometric parameters analyzed showed significant differences between the two groups. The contractile response to either carbachol or high K(+) was not significantly different, whereas the contractile response to electrical field stimulation was significantly higher in the HFD group. In the HFD group, the mean total cholesterol level was significantly higher. The present results suggest that HFD-feeding for 20 weeks in mice unlikely affects bladder function even though it induced diabetes, hyperlipidemia and tachycardia.

A One-Day Frequency-Volume Chart is Representative of a 3-Day Chart in the Assessment of Lower Urinary Tract Symptoms Suggestive of Bladder Outflow Obstruction

Introduction: 24-h frequency-volume (FV) charts are often used to assess patients with lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO). There are no clear guidelines regarding the optimum chart duration. We aimed to determine whether a one-day FV chart is representative of a 3-day equivalent. Patients and methods: Men presenting with LUTS (including nocturia) were prospectively recruited and completed a 3-day FV chart. Exclusion criteria were previous bladder outflow surgery and anti-cholinergic medication. Results: 285 patients were recruited (mean age, 67 years; range 26–93 years). There were no significant inter-day differences in 24-h urine volume (24HUV) ( p = 0.10) and functional bladder capacity (FBC) ( p = 0.19). However, there were significant differences identified between days 1 and 2, and 1 and 3 for both nocturnal urine volume (NUV) ( p &lt; 0.001) and actual nocturnal voids (ANV) ( p &lt; 0.001) despite significant correlation of these parameters on each day with their respective 3-day means. Conclusion: Our data suggest that a one-day FV chart is representative of a 3-day equivalent for the assessment of 24HUV and FBC in patients with LUTS/BOO. Further studies are required to compare the repeatability and clinical utility of a one-day chart compared with 3- and 7-day charts, particularly in patients with nocturia.

1530 FUNCTIONAL BLADDER CAPACITY, IS THERE A DIFFERENCE BETWEEN DAY AND NIGHT? A COMMUNITY-BASED STUDY IN OLDER MEN

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction I1 Apr 20101530 FUNCTIONAL BLADDER CAPACITY, IS THERE A DIFFERENCE BETWEEN DAY AND NIGHT? A COMMUNITY-BASED STUDY IN OLDER MEN Boris van Doorn, Esther T. Kok, Marco H. Blanker, and J.L.H. Ruud Bosch Boris van DoornBoris van Doorn Utrecht, Netherlands More articles by this author , Esther T. KokEsther T. Kok Utrecht, Netherlands More articles by this author , Marco H. BlankerMarco H. Blanker Groningen, Netherlands More articles by this author , and J.L.H. Ruud BoschJ.L.H. Ruud Bosch Utrecht, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1281AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A decreased nocturnal functional bladder capacity (NBC) is commonly regarded a reason for increased nocturnal voiding frequency (nocturia). However, there are arguments for a larger functional bladder capacity at night. Because - in physiologic circumstances - the bladder is filled more slowly at night, sensory nerve traffic to the central nervous system should be less and at the same time the level of arousal during sleep is lower. Therefore, we hypothesize that NBC is larger than the diurnal bladder capacity (DBC). To verify this we compared NBC and DBC in a community-based group of older men. METHODS We conducted a population-based study among 1,688 men aged 50 to 78 years old. Data were obtained using a Frequency Volume (FV)-chart, from which the following parameters were determined: NBC, determined as the largest single voided volume during sleep or “Cif one did not void during sleep- as the first void within one hour of arising; DBC: largest single voided volume when awake, and the nocturnal voiding frequency (NVF). Nocturia was defined as NVF ¡Ý3). We regarded NBC < DBC as decreased NBC (dNBC). We estimated prevalence rates for dNBC in different age groups, and compared differences in volume of NBC and DBC within and between the groups. RESULTS Of all, 812 FV charts men were eligible for analyses. Overall, 36.2% of the men had a dNBC. The prevalence of dNBC was slightly lower in men with nocturia (33,1%) than without nocturia (36.9%, chi-square p=0.381). The NVF was not higher for men with a dNBC (p=0.284). Overall, NBC (median 325 mL) was larger than DBC (310 mL; Mann Whitney U test, p = 0.077). Both NBC and DBC were smaller in men with nocturia (300, resp. 280 mL, difference within group, p = 0.03) than men without nocturia (350 and 330 mL, difference within group, p=0.284); both NBC and DBC differed between the nocturia- and the non-nocturia group (p < 0.001). CONCLUSIONS For all ages, men with nocturia have smaller NBC and smaller DBC than men without nocturia. NBC was larger than DBC in the nocturia group but not in the non-nocturia group. The prevalence of dNBC was slightly lower in men with nocturia than without nocturia. This is in contrast to our hypothesis. Our data show that both NBC and DBC are smaller in men with nocturia. This suggests that a smaller NBC is not just a nocturnal phenomenon, but reflects a decreased functional bladder capacity in general. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e590 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boris van Doorn Utrecht, Netherlands More articles by this author Esther T. Kok Utrecht, Netherlands More articles by this author Marco H. Blanker Groningen, Netherlands More articles by this author J.L.H. Ruud Bosch Utrecht, Netherlands More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Voiding patterns in men and women with lower urinary tract symptoms combined with nocturia

We evaluated differences between men and women with lower urinary tract symptoms (LUTS) combined with nocturia. A total of 71 age-matched female-male pairs (median 58, range 20-81 years) who had moderate to severe LUTS and nocturia of more than once per night were enrolled in this study. In the younger group (<50 years), the International Prostate Symptom Score (I-PSS) results of the sexes were not significantly different. However, although total I-PSS results in the elderly group (> or =50 years) were not significantly different, quality of life index scores for women were higher (P = 0.002). On frequency-volume (FV) charts, mean total daytime voided volume (DVV) was significantly higher in younger men than in younger women (P = 0.017), but the mean nocturnal polyuria index (NPi) for women was higher than that for men (P = 0.047). However, maximum DVV (P = 0.009), mean DVV (P < 0.0001), total DVV (P < 0.0001), and mean nocturnal urine volume (P = 0.009) were significantly higher in elderly men than in elderly women. However, numbers of daytime voids were not different. Elderly women with LUTS have lower functional bladder capacities than elderly men, as suggested by their smaller mean voided volumes. However, no significant differences were observed between numbers of daytime voids, which was probably due to the smaller total daytime voided volumes of elderly women. In addition, although NPi for younger women and nocturnal urine volume for elderly men was higher, no other differences were observed in terms of other night-time parameters.

The Relationship between Objective Frequency–Volume Chart Data and the I-PSS in Men with Lower Urinary Tract Symptoms

ObjectiveThe International Prostate Symptom Score (I-PSS) is considered a benchmark in defining the severity of lower urinary tract symptoms (LUTS). However, its relationship with variables of the frequency–volume (FV) chart, an objective measure of LUTS, is not well understood. We analyzed this relationship between the I-PSS and FV chart variables in men with LUTS. MethodsPatients referred for the investigation of uncomplicated LUTS completed an I-PSS and a 3-d FV chart. Correlation coefficients were used to describe the relationship between total I-PSS and its components with the FV variables. The distributions of FV variable scores within the categories of I-PSS severity were also examined. The effect of patient’s quality of life score on I-PSS and FV variables was analyzed using regression. ResultsA total of 104 patients completed both the I-PSS and FV chart. The association between FV variables and I-PSS scores was generally weak, with 24-h frequency being the strongest (r=0.43) and with considerable overlap within each severity category. There was weak association between the I-PSS for nocturia and urgency and their FV counterparts. The number of self-reported nocturnal voids tended to be overestimated. These discrepancies were partly explained by the patient’s quality of life rating, which reduced the level of variation between I-PSS score and FV variables and accounted for some of the overestimation. ConclusionWeak associations were found between the self-rated I-PSS scores and FV measures of voiding, suggesting that the accurate assessment of LUTS requires self-reported measures of symptoms and objective measures of voiding behaviour. Significant differences between the two types of data might be explained by perceived quality of life.

Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women

The objective of this study was to estimate the prevalence of nocturia in incontinent women in a urogynaecologic practice and its association with the quality of life and to estimate the prevalences of the pathophysiological categories among nocturics. From 1 January 2002, all patients with complaints of urinary incontinence were analysed according to a specific protocol: multichannel urodynamic testing, a 1-h International Incontinence Society (ICS) pad test and a 3-day frequency-volume (FV) chart. From 1 June 2002, subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. Evaluable FV charts were received from 111 patients, and 72 patients completed the questionnaires correctly. The overall prevalence of nocturia was 48.6% (confidence interval: 43.9-53.3%). Nocturia had a negative impact on several aspects of the quality of life. The maximum voided volume was significantly (p=0.005) less in nocturics. The 24-h frequency was higher in nocturics (p=0.001). Nocturics lost more urine during the pad test (p=0.039). The multivariate logistic regression analysis showed that the greater the proportion of 24-h urine excreted at night, the greater the odds of having nocturia and that the lesser the maximum voided volume, the greater the odds of having nocturia. The majority (92.7%) of the nocturics can be classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 51.2%, a low functional bladder capacity in 14.6%, a combination of both in 9.8%, polyuria in 4.9% and a combination of polyuria and nocturnal polyuria in 12.2% of the cases. Nocturia is a frequent symptom among urinary incontinent patients, with a negative impact on several aspects of the quality of life. With a FV chart, nocturics can be classified into one of the responsible pathophysiologic categories in the majority (92.7%) of the cases.

Is questionnaire enough to assess number of nocturic episodes?: Prospective comparative study between data from questionnaire and frequency-volume charts

ObjectivesTo determine whether the voiding symptom questionnaire provides information regarding nocturia as accurate as that provided by frequency-volume (FV) charts, we evaluated patients with lower urinary tract symptoms. MethodsWe prospectively analyzed 164 patients (62 men and 102 women, mean age 53.6 years, range 20 to 83) referred for the evaluation of lower urinary tract symptoms. At the initial visit, all patients answered the International Prostate Symptom Score (IPSS) questionnaire to quantify nocturia and subsequently were requested to complete a 3-day FV chart. ResultsThe differences in age between the men and women were not statistically significant. The total IPSS and IPSS bother scores were similar between the sexes. For all patients, the actual number of nightly voids in the FV charts and the IPSS nocturia score were modestly intercorrelated (r = 0.609, P <0.001). However, large individual differences were found in the nighttime diuresis rate (67.7%) between the IPSSs and FV charts. No statistically significant differences were found between men and women, but agreement was achieved in only 39.2% of patients younger than 60 years old and 22.4% of those 60 years old or older for the number of voids per night recorded by the FV charts and reported by the IPSS (P = 0.024). Overestimation of the number of nocturic episodes in the IPSS was more common than underestimation, especially in patients 60 years old or older (P = 0.014). ConclusionsThe findings of the present study revealed poor agreement between the subjectively estimated nocturnal frequency and chart-determined nocturnal frequency. Our results suggest that FV charts should be included as an integral part of evaluating nocturia in both sexes.

Nocturia and complementary indices: determination and quantification of the cause of nocturia by frequency-volume charts in women with lower urinary tract symptoms.

We evaluated differences between women with lower urinary tract symptoms (LUTS) with and without nocturia in terms of voiding habits, urine production and voided volumes in order to determine and quantify the cause of nocturia by using frequency-volume (FV) charts. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score assessment, received a thorough explanation from the study coordinators, and were requested to complete a 3-day FV chart. Of the 123 women enrolled, 106 (86.2%) 20-83 years old (median age 55.0) completed the study. Nocturnal urine volume was higher in nocturics than in non-nocturics, but this was not statistically significant. Total daytime voided volume was lower in nocturics than in non-nocturics ( P=0.030) but with no detectable difference in total voided volume. To identify possible risk factors, we examined age and night time parameters including the nocturnal bladder capacity index (NBCI), nocturnal polyuria index (NPI) and nocturia index (NI) by univariate logistic analysis. When nocturia was defined as voiding at least twice per night, age and NI were found to be associated with it by univariate analysis. These two variables were further analyzed using a multivariate logistic model to determine their association with nocturia. In the multivariate analysis, a positive association was observed between age and nocturia. Patients 50 years or older had a 3.9-fold higher risk [odds ratio (OR) 3.86; 95% confidence interval (CI) 1.60-9.31; P=0.003] of voiding at least twice per night than those younger than 50 years. In the same model, patients with NI greater than 1.5 had a 4.5-fold higher risk of voiding at least twice per night (OR 4.59; 95% CI 1.80-11.17; P=0.001). FV charts are valuable for determining the cause of nocturia in women with LUTS. Our findings suggest that age and the NI may be important variables in the evaluation of nocturia in women with LUTS.

Intravesical infusion of resiniferatoxin by a temporary in situ drug delivery system to treat interstitial cystitis: a pilot study.

Interstitial cystitis (IC), a syndrome characterized by motor and sensory dysfunction of the lower urinary tract, represents a diagnostic and therapeutic challenge even to highly skilled physicians. We investigated the technical feasibility and the clinical efficacy of a prolonged intravesical instillation of RTX by in situ drug delivery system in patients with IC. 5 female patients (mean age 48.7 years) received a prolonged infusion of a saline solution containing 10nM of resiniferatoxin at the flow rate 25microl/h by the MiniMed 407C Infusion Pump (MiniMed Sylmar, CA, USA), connected to sovrapubic 5Fr mono Pigtail catheter, for 10 days. All patients reported frequency, nocturia and urgency, and symptoms of pelvic pain for at least six months. They showed the absence of urinary tract infection within the last three months, the absence of functional disorders of lower urinary tract and no other vesical or urethral pathology. The pre-treatment (PT) frequency/volume (FV) chart and a pain score (VAS score) were recorded. Patients were evaluated after 30 days from the end of infusion (primary end point, PEP) and after three months (secondary end point, SEP). At PEP frequency reduced from 11.3+/-1.39 to 7.4+/-1.51 (p<0.01) and nocturia from 3.6+/-0.54 to 1.2+/-0.44 (p<0.01). A highly significant reduction of pain score was observed at PEP: it decreased to 2.4+/-0.54 from 6.7+/-0.83 (p<0.01). The pain score remained significantly lower at SEP (3.2+/-0.44 p<0.05). Nocturia was also statistically reduced at SEP (1.9+/-0.74) as well as frequency (8.7+/-1.76). No side effects were reported during the infusion as well as after the removal of the catheter. The present study demonstrates that the prolonged intravesical instillation of a drug by in situ drug delivery system is a feasible procedure and seems to support the efficacy of RTX in the treatment of IC patients. However further studies are necessary and mandatory to confirm our results and to define the exact action mechanism of prolonged infusion of RTX, the dosage and the treatment schedule.

Frequency‐volume chart: The minimum number of days required to obtain reliable results

There is wide variation in the number of days necessary to maintain a diary and still furnish reliable data on which to base a sound clinical assessment. Estimates range from 1 day to 2 weeks, 7 days probably being the criterion standard. The goal of this retrospective study was to evaluate how much the 7-day period could be shortened without compromising the reliability of data. Various lengths of frequency-volume (FV) charts (from 1 day to 6 days) were compared with the standard 7-day charts on 14 FV parameters. Overall results show that a 4-day dairy is nearly identical to the 7-day chart (most r > or = 0.95). Results of the 1-, 2-, and 3-day charts were frequently different statistically from the 7-day chart, whereas comparison of the 4-day chart with the 7-day chart showed no statistically significant differences. In addition, results of 4-day FV charts from a new control cohort showed no significant differences from the 7-day charts of the main cohort. In conclusion, our study indicates that the 4-day chart is as reliable as the 7-day chart. This reduction in the length of time, although easier for the patients, does not compromise the diagnostic value of the FV charts.

One 24-hour frequency-volume chart in a woman with objective urinary motor urge incontinence is sufficient

Objectives. To determine whether one 24-hour frequency-volume (FV) chart in a woman with objective urinary motor urge incontinence is sufficient to gain insight into her voiding habits. Methods. Retrospectively, women 18 years old and older with urodynamically confirmed urinary motor urge incontinence without neurologic disease or other urologic pathologic findings, who correctly completed two or three 24-hour FV charts during normal daily life, were studied. For each patient, we compared the voiding parameters (mean voided volume, diuria, nocturia, minimum and maximum voided volumes, and total voided volume) and fluid intake calculated from the first FV chart with the same data calculated from all the FV charts. Results. Ninety-eight adult women were recruited. A marked dropout occurred, and 60 patients remained to be evaluated (mean age 54.5 ± 15.5 years). The calculated voiding parameters agreed with those in published reports. Strong associations existed between all voiding parameters and fluid intake calculated from the first FV chart and those calculated from all FV charts ( P <0.001 for all parameters). Compared with the well-known variability, the differences between the voiding parameters calculated from the first FV chart and those from all charts were small. These results agreed with studies in other patient groups (benign prostatic hyperplasia and interstitial cystitis) that analyzed the use of only one 24-hour FV chart. Conclusions. The use of only one 24-hour FV chart completed during normal daily life by a woman with objective urinary motor urge incontinence is sufficient to gain insight into her voiding habits.