Nighttime Voiding Research Articles

Childhood extraordinary daytime urinary frequency—a case series and a systematic literature review

Childhood extraordinary daytime urinary frequency is likely a common but underreported condition characterized by daytime frequent voiding and typically not linked with complaints of burning, urinary incontinence, altered urinary stream, changes in the nighttime voiding pattern, excessive fluid intake and excessive urinary volume. To determine the features and outcome of extraordinary daytime urinary frequency, we report our experience with 14 children and the results of a formal systematic analysis of peer-reviewed English-language literature on this topic. Nineteen case series were found (together with 16 mostly pertinent comments), with each case series providing details on from one to 119 children. On the basis of our experience and the findings of our systematic analysis, we conclude that, in general practice, extraordinary daytime urinary frequency is a common cause of urinary frequency, that the age of such patients is, on average, 6 years and that the micturation abnormalities persist for an average of 6 months. The results of this review must be viewed with an understanding of the limitations of the analysis process, which incorporated data exclusively from case series.

Does increased urination frequency protect against bladder cancer?

Experimental studies suggest that increased urination frequency may reduce bladder cancer risk if carcinogens are present in the urine. Only 2 small studies of the effect of increased urination frequency on bladder cancer risk in humans have been conducted with conflicting results. Our purpose was to evaluate the effect of urination frequency on risk of bladder cancer in a large, multicenter case-control study. We analyzed data based on interviews conducted with 884 patients with newly diagnosed, bladder cancer and 996 controls from 1998 to 2001 in Spain. We observed a consistent, inverse trend in risk with increasing nighttime voiding frequency in both men (p = 0.0003) and women (p = 0.07); voiding at least 2 times per night was associated with a significant, 40-50% risk reduction. The protective effect of nocturia was apparent among study participants with low, moderate and high water consumption. The risk associated with cigarette smoking was reduced by nocturia. Compared with nonsmokers who did not urinate at night, current smokers who did not urinate at night had an OR of 7.0 (95% CI = 4.7-10.2), whereas those who voided at least twice per night had an OR of 3.3 (95% CI = 1.9-5.8) (p value for trend = 0.0005). Our findings suggest a strong protective effect of nocturia on bladder cancer risk, providing evidence in humans that bladder cancer risk is related to the contact time of the urothelium with carcinogens in urine. Increased urination frequency, coupled with possible dilution of the urine from increased water intake, may diminish the effect of urinary carcinogens on bladder cancer risk.

A population‐based study of urinary symptoms and incontinence: the Canadian Urinary Bladder Survey

To ascertain the prevalence of lower urinary tract symptoms (LUTS) and urinary incontinence (UI) in Canada, using a cross-Canada telephone survey, as there is a wide discrepancy in the reported prevalence of these conditions. A random survey with a standardized questionnaire was conducted to elicit responses from 1000 adults, aged >or= 18 years; the sample was intended to reflect the population census. Data on age, level of education and household income were obtained from all respondents. All participants were questioned about urinary symptoms and daytime and night-time voids. For those who reported more symptoms than one episode of nocturia a more detailed questionnaire was used to ascertain symptom severity and duration. Data were analysed from 1000 respondents (482 men, mean age 44 years; 518 women, mean age 45 years). Half the respondents (43% of men and 57% of women) reported one or more LUTS, with nocturia the most common, at 36%. Overactive bladder (OAB) symptoms (urgency, with or with no urgency UI, usually with frequency and nocturia) were reported by 13.9% of respondents (13.1% of men and 14.7% of women). UI was reported by 28.8% of women with the 68% of these having stress UI (SUI), followed by mixed UI (MUI) in 21%, and urgency UI (UUI) in 11%. Of the 5.4% of men with UI, 27% had SUI, 15% had MUI, and 58% had UUI. Overall, the prevalence of LUTS increased with age. Respondents reported that symptoms were present for a median of 5 years. LUTS and UI are common in the Canadian population and increase with age. The prevalence in Canada of these conditions is similar to that seen in other countries.

Cambios en la sintomatología miccional de la incontinencia urinaria de esfuerzo tras la cirugía con técnicas de cabestrillo transvaginal

To evaluate the changes in voiding symptoms in female patients with stress urinary incontinence (SUI) undergoing transvaginal sling techniques over a five-year period in the Department of Urology at the University Hospital of Albacete.Between November 2001 and December 2005 126 patients with SUI (mean age 57.09 years; 36-78) underwent transvaginal sling techniques (Sling in Fast, TVK TOT). All patients were evaluated clinically and urodynamically.Average body mass index (BMI) was 28.14 kg/m2 (SD 4.66; 95% CI: 27.32-28.96). 92 patients (73%) presented between 2-4 previous pregnancies. 99 patients (80.9%) have had birth labour between 2 and 4 times. All of them were vaginal birth labours except 12 cases (9.5%) in which caesarean section had been performed. Daytime voiding frequency after surgery was over 120 minutes in 112 patients (88.9%). Night-time voiding frequency was equal or less than twice in 110 patients (87.3%). 104 patients (82.5%) presented at least two leaking episodes per day, and 105 patients (83.3%) needed to wear one pad per day or less during the last week before follow-up visit. The number of urinary leak episodes per day diminished in 114 patients (90.5%) with a mean decrease of 9.65 episodes (95% CI: 8.56-10.79) (p < 0.0001). Ninety-four patients (76.4%) were completely dry.Development of new surgical techniques for the treatment of SUI have improved results and diminished the number of complications, an expression of which is the favourable evolution of voiding changes after surgery.

Incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario inferior en el cistocele

The association of stress urinary incontinence secondary to urethral hypermobility and lower urinary tract obstruction in the same patient with cystocele is rare, and even represents a contradiction. The objective of our work is to treat to define the characteristics that identify this entity, in comparison with isolated stress urinary incontinence or lower urinary tract obstruction in patients with cystocele. We performed a retrospective study in 1168 cases of cystocele in which urodynamic studies were performed. All patients underwent history and neurological and uro-gynecologycal physical examination. The urodynamic study included uroflowmetry, cystomanometry, voiding pressure/flow tests and voiding cystourethrograms. All data were collected in an Excel 2000 database and statistical analysis was performed with the SPSS software. A- General data: 25 cases qualified for the study in group I (isolated stress urinary incontinence with urethral hypermobility); 24 cases in group II (lower urinary tract obstruction); and 14 cases in group III (astress urinary incontinence associated with lower urinary tract obstruction). The proportion of each group in the whole group of cystoceles corresponded to a 4/1/0.05 ratio respectively. Mean age was 58.4 years for group I, 68.2 for group II and 71.2 for group III. A Statistically significant lower age was demonstrated for group I (p < 0.0005). B- The symptom "sensation of vaginal lump" was less frequent in group I (32%). A significant difference was demonstrated (p = 0.02). C- Group I showed a lower increase of daily voiding frequency (32%), p = 0.02. D- Group I showed less night-time voiding frequency (1 episode)(p < 0.04). E- Urinary incontinence with cough was less frequent in group 1 (84%) (p = 0.0004). F- Group I had more bladder capacity (243.6 ml) (p < 0.05).G- Group I showed less urethral resistances (URA = 37.9 cm H2O) (p = 0.01). H- W80-W20 was higher in group I: 1.3 W/m2 (p < 0.05). I- The symptom "sensation of vaginal lump appeared more often in group II (70.8%) (p = 0.02). J- Radiological degree of cystocele was greater in group II1 (1.7) (p < 0.05). K- Detrusor hyperactivity was more frequent in group III (64.3%) (p = 0.00009). L- No significant differences were found between groups II-III when comparing type of obstruction. The group of isolated stress urinary incontinence (group I) is characterized by a younger age, less frequency of sensation of vaginal lump, less daily frequency and nocturia, and urodynamic data of greater bladder capacity, lower urethral resistance and normal detrusor contractility. The group of isolated lower urinary tract obstruction (group II) could be characterized by a more frequent sensation of vaginal lump and increase of the radiological cystocele. The group of stress urinary incontinence associated with lower urinary tract obstruction had a higher percentage of cases of detrusor hyperactivity. All these data might enable a proper identification of different risk elements in the groups.

Seasonal Alterations in Nocturia and Other Storage Symptoms in Three Japanese Communities

To conduct a community-based questionnaire study to uncover the relationship between climates and lower urinary tract symptoms. A total of 6000 residents aged 41 to 70 years were randomly selected in three Japanese towns (Tobetsu in a subartic zone, Kumiyama in a temperate zone, and Sashiki in a subtropical zone). A self-administered questionnaire, which included the International Prostate Symptom Score, and overall incontinence score from the International Consultation on Incontinence Questionnaire Short Form was mailed to one half of the targets in the summer and the remaining one half in the winter. A logistic regression model was used for the main statistical analysis, with P <0.05 considered significant. A total of 1124 responses (37.5%) to the summer study and 1156 (38.5%) to the winter study were available for analysis. Three storage symptoms (frequency, urgency, and nocturia) demonstrated statistically significant differences between the two seasons. Multivariate logistic regression analysis revealed that winter was an independent risk factor of frequency (score of 1 or more, P <0.0001, odds ratio [OR] 1.47; and score of 2 or more, P = 0.0089, OR 1.30), urgency (score of 1 or more, P = 0.0022, OR 1.38), and nighttime voiding (score of 2 or more, P = 0.0012, OR 1.40). This tendency was marked in the subtropical zone but was not observed in the subartic zone. These findings suggest that epidemiologic studies focusing on the prevalence of lower urinary tract symptoms should take into consideration the impact of seasonal changes, especially in communities in warmer zones.

尿失禁を伴う高齢者過活動膀胱症例に対する干渉低周波療法の有用性

Examining the clinical efficacy on the interferential low frequency therapy for elderly overactive bladder (OAB) patients with urinary incontinence prospectively, for whom anticholinergics were not effective. Subjects are 80 patients over 65 years with urinary incontinence, who are clinically diagnosed with OAB. For over three months, they were administered anticholinergics (20mg/day propiverine hydrochloride), but in an interview after the administration period they responded that their QOL indexes were 4 (mostly dissatisfied) or over. After the anticholinergics had been washed out for over one week, the patients were provided with interferential low frequency therapy (IF) alone for three months using the Uromaster" (made by Nihon Medix Co.). Before and after IF, the following items were examined. 1) Frequency of IF treatment required to show optimal effects subjectively, 2) Average incontinence frequency in a week, 3) PAD test for 60 minutes, 4) Frequency and voided volume in the daytime and nighttime, 5) Fluid intake volume, 6) IPSS, QOL index, 7) UFM (voiding time, voided volume, Qmax, Qave), 8) PVR (postvoid residual urine), 9) Specific gravity of urine, 10) Average hours spent outside per day, 11) Average radius of action per day, ADL scale, 12) Blood pressure and pulse in the standing position, 13) Values of clinical examination, 14) Adverse events of IF., 15) Plasma osmotic pressure, 16) BNP (Brain natriuretic peptide). During the trial, no behavioral advice, including fluid intake advice, was provided to the patients. Before starting this study, all patients signed an informed consent agreement. 1) After a median of eight treatments of IF, the patients showed significant improvements subjectively and this effect continued. Improvement was observed in the following items. All these values showed [The mean value before IF]-->[The mean value after IF for three months], and statistically significant differences were identified between before and after IF in all these values (p< 0.0001 except nighttime voiding frequency [p = 0.0004]). 2) Incontinence frequency; 13.3-->3.6 times/week, 3) PAD test; 17.5-3.1gr., 4) daytime voiding frequency; 8.3-*7.0 times, nighttime voiding frequency; 1.8-->1.4 times, 6) IPSS; 12.1-->6.3, QOL index; 5.2-->2.4, 7) Voided volume; 170.2-->254.2ml, Qmax; 18.1 -->25.7ml/sec, Qave; 8.9-->12.1ml/sec, 10) Average hours spent outside; 1.5-->3.0hrs., 11) Average radius of action; 400-->1,200m, ADL scale; 8.0-->3.4, 12) Blood pressure in the standing position; 132.9/ 79.7-->127.1/74.7mmHg., 15) Plasma osmotic pressure; 295.1-->297.8 mOsm/1, 16) BNP; 41.3-->19.2 pg/ ml. Other items including clinical examination and pulse did not change much, while the adverse events of IF were not recognized. The results indicate the possibility that IF has safe and better effects than anticholinergics on the elderly OAB patients with urinary incontinence. It is clear that the OAB can significantly impair the QOL and reduce the ADL. By improving the urgent incontinence, the QOL will be improved and the physical activity may increase.

Voiding Pattern of Healthy Taiwanese Women

Aim: Few studies have examined the voiding pattern of healthy females, despite the importance of such research for diagnosing abnormal voiding behavior. This study investigates the voiding behavior of healthy women in Taiwan. Methods: 68 healthy women, aged 19–66 years and claiming to void normally were enrolled. Twenty-two of the subjects (32.4%) were postmenopausal. Each woman completed a 3-day voiding diary. The diary recorded urine volume, voiding frequency, urine volume per voiding for the whole day (24 h), and urine volume during both daytime and nighttime. Age and various other voiding parameters were correlated, and the voiding patterns were compared between premenopausal and postmenopausal women. Results: All women voided 7.34 ± 1.63 times daily. Higher age was associated with higher whole day and daytime voiding frequency. Nocturia was not common for the group as a whole, with a mean nocturnal voiding of 0.25 times per night. However, higher age was significantly associated with a higher nighttime voiding frequency. A significantly positive correlation was also observed between age and whole day urine volume. Compared with regularly menstruating women, postmenopausal women had a significantly higher whole day and nighttime voiding frequency. Menopause and age both independently affect voiding parameters after multivariate analysis. Conclusions: The results of this study provide invaluable baseline data on female voiding behavior. Additionally, this study found that for healthy women, age and menstruation status significantly affect voiding patterns. Analysis of female voiding behavior thus should consider these two factors.

Impact of stress urinary incontinence and overactive bladder on micturition patterns and health-related quality of life

We examined the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on micturition habits and health-related quality of life (QOL). A total of 250 Korean women were included in the study. The Medical Outcomes Study Short Form (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient (SUI, n=158 and OAB, n=92) and control (n=70) groups. A control group was recruited at the Health Promotion Center of our hospital. Each of the dimension scores in the SF-36 represents better health, while that of the KHQ does worse health perception. On the frequency-volume charts, patients with OAB had more nighttime voids than those with SUI (P=0.001). Of the eight domains in the SF-36 questionnaire, four domains were significantly different between the control and OAB groups. Patients with SUI had a significantly lower score on one domain than the controls. Between the SUI and OAB groups, only one domain showed a significant difference. Regarding the KHQ, all domain scores in control subjects were significantly lower than those in the SUI and OAB groups. Between the SUI and OAB groups, the OAB group had higher scores on 'general health perception' and 'sleep/energy disturbances', while the scores of 'physical limitations' and 'severity measures' were higher in the SUI group. Women with OAB have a higher number of nocturic episodes than those with SUI, but the QOL is not less affected by SUI than by OAB. Furthermore, simultaneous disease-specific QOL instruments should be used in the evaluation of urinary incontinence because the generic QOL instrument is not a sensitive tool for measuring QOL in this population.

Variability of 24-hour voiding diary variables among asymptomatic women.

We determine whether urinary diary values are stable over time among women without lower urinary tract symptoms. Women without lower urinary tract symptoms completed a 24-hour log of fluid intake and volumes voided during June/July 2001 and again during February/March 2002. Initial and repeat diaries were compared using Wilcoxin signed rank tests, considered significant at the 5% level. A total of 137 subjects completed both diaries. Subjects voided a median of 8 times per 24 hours during the first and 7 per 24 hours during the second diary with 95% of subjects recording fewer than 13 voids per 24 hours during both diaries. Nighttime voids were recorded by 59 (43%) subjects during the first and 54 (39%) during the second diary. Urinary frequency and total urine volume were significantly greater during the first than second diary (Z = 2.1, p = 0.03 and Z = 3.3, p = 0.001, respectively). No significant differences in mean voided volume, maximum voided volume, voids per liter intake, total intake, or daytime or nighttime diuresis rates were found when the groups were compared. However, there were large individual differences in all diary variables. While there is large individual variation in diary values, pooled data from 24-hour urinary diaries concerning voids per liter intake, and mean and maximum voided volumes remain stable. Pooled data concerning raw urinary frequency and urine volumes may vary significantly without any treatment. When urinary frequency is of interest, the number of voids per liter intake may represent the most stable measure.

Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow‐up into adolescence, with attention to the clinical value of normalizing bladder capacity

To assess the importance of normalizing bladder capacity to the age-expected capacity in children with refractory monosymptomatic nocturnal enuresis (MNE), and to evaluate the long-term results when these children grow into adolescence. The study included 34 children with refractory MNE; all were treated > 5 years earlier for their MNE using a combined stepwise approach, consisting of retention control training, oxybutynin and an enuresis alarm. Data were obtained on their enuretic state, night-time voiding behaviour and bladder capacity, from a questionnaire and a voiding chart. Before starting treatment, all patients had a bladder capacity that was too small for their age. After the combined stepwise approach, MNE improved in all patients and 24 (71%) were cured. Although the bladder capacity was increased to the age-expected capacity in 26 (76%), most woke at night to void. Currently, at a mean of 7.7 years after the primary treatment, 28 (82%) of the patients are completely dry at night, of whom 15 (54%) arouse to void for 35% of the nights. Six patients (18%) still have some enuretic episodes. Only those who were dry after primary treatment and remained dry had a normal age-expected increase in bladder capacity. For all others there was a decrease in age-related bladder capacity. In patients with refractory MNE, a combined stepwise approach improves and may even eliminate enuresis, but normal night-time bladder behaviour in adolescence and adulthood is only achieved in some. Furthermore, about a fifth still have some enuretic episodes.

Relevance and variability of the severity of incontinence, and increased daytime and night‐time voiding frequency, associated with quality of life in men with lower urinary tract symptoms

To estimate the distribution of the severity of urinary incontinence (UI) and daytime and night-time voiding in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH); to estimate the proportion of 'subjectively relevant' symptoms within each severity category; to identify differences in quality of life (QoL) by degree of subjectively relevant daytime and night-time symptoms; and to identify differences in QoL in men with subjectively relevant UI or no UI. Data from a group of 480 men awaiting urological assessment for LUTS suggestive of BPH were collected by questionnaire shortly after referral from their general practitioner in 1997-2000. The International Continence Society--Benign Prostatic Hyperplasia Index, Sandvik's Incontinence Severity Index, and the World Health Organization Quality of Life Survey--Abbreviated Version (WHOQoL-bref) were used to assess symptoms and QoL. There was a large heterogeneity of self-reported symptom severity and related bother in the three symptoms of UI, increased daytime voiding frequency and night-time voiding in these referred patients. The WHOQoL-bref showed significant group differences of subjectively relevant symptoms. The perception of increased night and daytime frequency, as measured by symptom severity and bother, varied greatly. The severity of UI and its effect on men waiting for a urological assessment of LUTS suggestive of BPH also varied widely. In general, the symptoms and their impact were slight to moderate. The WHOQoL-bref could be used to differentiate among groups of subjectively relevant symptoms, and in so doing supported information generated by the bother question.

Nocturnal polyuria in women with overactive bladder symptoms and nocturia

This study was undertaken to determine the prevalence of nocturnal polyuria in women complaining of nocturia and overactive bladder (OAB) symptoms and to identify clinical and health characteristics associated with nocturnal polyuria. Women presenting to a urogynecology clinic with complaints of nocturia and OAB symptoms were asked to participate. They completed a health characteristic summary, 3-day voiding diary, Nordic sleep questionnaire, urinary distress inventory (UDI), and a nocturia distress visual log (NDVL). The 24-hour urine production, nighttime urine volume, and maximum bladder capacity were calculated from the bladder diary. Nocturnal polyuria was defined as production of greater than 33% of the 24-hour urine volume during an 8-hour sleep period. A histogram was performed to analyze at what age the prevalence of nocturnal polyuria increased. Women were then divided by presence or absence of nocturnal polyuria and compared by the health and clinical characteristics. Fifty-five women met the qualifications and participated in the study. Average age of the cohort was 65.8 +/- 13.5 years. The risk of nocturnal polyuria increased with age 65 years or older (prevalence for age 65-74 = 0.86 [0.62-1.00]) and with white race. On the basis of the mean population values for UDI, NDVL, sleepiness scores, and insomnia scores, all women were bothered by their nocturia. Median number of nighttime voids, 24-hour urine production, maximum bladder capacity, nocturnal index, UDI, NDVL, sleepiness scores, and insomnia scores did not differ, based on presence or absence of nocturnal polyuria. Among women complaining of nocturia and overactive bladder symptoms, age 65 years or older and white race appear to be risk factors for nocturnal polyuria.

Treatment of interstitial cystitis with Cystistat®, A hyaluronic acid product

To determine whether intravesical hyaluronic acid id effective in reducing the urinary frequency and pain associated with interstitial cystitis/painful bladder syndrome (IC/PBS). In a prospective, unblinded, uncontrolled pilot study, 20 patients (age range 34-80 years), all suffering from IC/PBS, received weekly bladder instillations of hyaluronic acid for 1 month and monthly instillations for a further 2 months. Patients were then offered further monthly instillations and all were subsequently evaluated after 3 years. Patient outcomes assessed were urinary frequency, use of analgesics and pain. All patients completed the 3 months of hyaluronic acid treatment with mean decreases in nocturia and pain of 40% and 30%, respectively, and decrease in analgesic use. Thirteen patients (65%) responded to treatment (responders) and continued therapy, while seven patents withdrew, six because of a lack of response and one due to cystectomy. In the 13 patients who continued hyaluronic acid instillations, four complete responders(30%) ceased therapy after a strong positive response (36%, 60% and 81% decreases compared to baseline in day-time voids, night-time voids and scores, respectively) which was maintained in the absence of continuous therapy, while after 3 years seven partial responders (35%) were still on therapy (25% and 43% decreases compared to baseline in day-time voids and pain scores, respectively). Two patients developed other diseases during follow-up and showed no response to long-term therapy. Hyaluronic acid was will tolerated by all patients. Hyaluronic acid safely reduced the pain and, to lesser degree, the urinary frequency associated with IC.

Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra

To detail, in a review, one institution's 6-year experience using botulinum toxin A (BTX-A) in the bladder and urethra in 110 patients for a variety of lower urinary tract disorders. A total of 110 patients (35 men and 75 women, age range 19 to 82 years) received injections of BTX-A into the bladder (n = 42) or urethra (n = 68). Voiding dysfunction included neurogenic detrusor overactivity and/or detrusor sphincter dyssynergia, overactive bladder, bladder neck obstruction, and interstitial cystitis. Under light sedation in most cases, patients were treated with either 100 to 200 U of BTX-A in 4 mL divided in equal doses into the four quadrants of the external sphincter or by injection into the bladder base using 100 to 300 U of BTX-A diluted in approximately 10 to 30 mL of sterile saline. At last follow-up, 27 patients had received additional injections (up to six) at intervals of 6 months or longer. All patients who underwent bladder BTX-A injection had preoperative evidence of involuntary detrusor contractions during urodynamic testing. Analysis of the 110 patients indicated that 67.3% reported a decrease or absence of incontinence. Diaries indicated a decrease in both daytime and nighttime voiding symptoms. Maximal efficacy occurred between 7 and 30 days and lasted for at least 6 months. Condition-specific quality-of-life symptom scores also demonstrated improvement. No long-term complications had occurred at last follow-up. Two women with multiple sclerosis and mild baseline stress urinary incontinence reported increased leakage with stress after BTX-A external sphincter injection, and one woman with multiple sclerosis noted new onset stress urinary incontinence after external sphincter injection. However, they all reported significant improvement in their detrusor sphincter dyssynergia with decreased postvoid residual urine volume, improved uroflow, decreased urge incontinence, and decreased daytime and nighttime frequency. One woman with multiple sclerosis who underwent bladder injection had increased postvoid residual urine volume from 78 to 155 mL. She did not have to perform intermittent catheterization. BTX-A injection is a safe and promising treatment modality for a variety of lower urinary tract dysfunctions for both skeletal and smooth muscle dysfunction. In our series, BTX-A is equally effective in women as it is in men. When injected into the sphincter, the risk of stress incontinence is low. Bladder injections with BTX-A are effective for not only neurogenic detrusor overactivity, but also overactive bladder. BTX-A can even be considered for interstitial cystitis.

Nocturia: The effect on sleep and related health consequences

Nocturia is one of the most bothersome complaints in men with lower urinary tract symptoms suggestive ofbenign prostatic obstruction (LUTS/BPO). Storage symptoms such as nocturia interfere considerably with the patient's performance of daily activities and quality of life. So far little attention has been paid as to why nocturia is such a trouble for men with LUTS/BPO and their partners. It is increasingly believed that disturbed sleep due to frequent awakenings at night resulting in reduced daytime energy and alertness is the underlying cause of the interference with daily-life activities and the reduced quality of life. It seems that in particular awakening during deep sleep, i.e. during the first third of the night, results in increased sleep inertia (i.e. performance impairment immediately after awakening) and reduced daytime performance. It has been shown that the prevalence of frequent night-time voiding interfering with sleep and leading to poor sleep, feeling tired during the day and poor health increases with the number of nocturnal voids. Disturbed sleep not only leads to reduced productivity and increase in the number of sick days, but nocturia and disturbed sleep can also have serious health consequences with a dramatic impact on patients, their family and society. Sleep deprivation has a detrimental effect on somatic and mental health, and is implicated in accidents and even increased mortality. Therefore, it is important to know how LUTS/BPO treatment improves nocturia, reduces disturbed sleep and improves the overall quality of life of patients. Preliminary data suggest that LUTS/BPO therapy reduces nocturia and that a reduction in the number of nocturnal voids during treatment for nocturnal polyuria improves the hours of undisturbed sleep in the first third of the night, when deep sleep predominates. However, further research is required to more precisely assess the impact of LUTS/BPO treatment on nocturia, disturbed sleep and quality of life. The Nocturia Quality of Life (N-QOL) questionnaire which is adopted in the International Consultation on Incontinence modular questionnaire may be a useful tool for this.

Degree of bother caused by nocturia in women.

The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

Relative Filling of the Bladder at Daytime Voids in Healthy School Children

We analyzed how healthy children use their bladder storage capacity during everyday life, and how transient changes in diuresis affect bladder filling and voiding intervals. Voided volumes and times were recorded during 1 or 2 24-hour periods by 206 healthy school children 7 to 15 years old. For each individual voided volumes were expressed as percentage of maximum voided volume (MVV). Mean diuresis preceding each void was estimated by dividing voided volume by voiding interval. A total of 1,098 voids were analyzed. The first void in the morning was the largest for a majority of the children (73%). Most daytime voids were considerably smaller than the individual MVV. Single voids less than half MVV occurred in 80% of the children, and more than one-third had voids smaller than 20% of their storage capacity. MVV was the same for children with different voiding frequency but the relative filling decreased with the number of voids per 24 hours. At high diuresis voids tended to occur at shorter intervals with somewhat larger relative filling of the bladder. Nighttime voids that occurred in 23 children were in most cases (19) much smaller than the individual MVV. Healthy children typically void when they want to, not necessarily when they need to, and only exceptionally with a full bladder. The voiding pattern is more dependent on social activities and convenience than on physiological factors such as bladder capacity, filling and diuresis.

Arginine Vasopressin and Nocturnal Polyuria in Older Adults With Frequent Nighttime Voiding

We determined in older adults whether frequent nighttime voiding is associated with urine overproduction at night or nocturnal polyuria (NP) and whether NP is associated with abnormalities of arginine vasopressin (AVP) blood levels and/or renal responsiveness to AVP. We used a convenience sample of adults 65 years and older in home and general clinical research center settings. A total of 45 participants completed the 3-day general clinical research center stay. We used 7-day voiding diaries to determine which participants had 2 or greater nighttime voids and NP, defined as 35% or greater of 24-hour urine output at night. Abnormalities in AVP release and secretion were determined by water deprivation testing and by twice daily blood AVP measurement. There was a strong positive association between the number of nighttime voids and the proportion of urine produced at night (r = 0.6, p <0.001). There was no association between NP and AVP blood levels or action. Participants with and without NP had similar maximum urine osmolality following water deprivation and exogenous AVP administration (mean 549 mOsm, range 422 to 713 and 547 mOsm, range 353 to 692, respectively). We found no association between NP and AVP abnormalities in this sample of older adults. Study participants had low maximal urine osmolality in response to fluid deprivation and exogenous vasopressin administration irrespective of whether they were identified as having NP.

Urinary Habits Among Asymptomatic Women

Three hundred women with no urinary symptoms completed a 24-hour urine frequency-volume chart, using 300-ml graduated measuring cups to record fluid intake and urine volume. They also noted rising and retiring times. The women were a median of 40 years of age (range, 18-91 years) with a median body mass index of 26 kg/m 2 and a median parity of 2. Twenty-six (9%) had undergone a hysterectomy. One fourth of the women were postmenopausal, with two thirds of them taking hormone replacement therapy. Black and white women represented 39% of the population each, 12% were Hispanic, and 9% were Asian. One woman classified herself as mixed race. Her results were not reported in the racial comparisons. Data from the subjects' diaries are reported in Table 1. The median number of voids each day was 8 (range, 4-18). The women had a median of 4 voids per liter of fluid intake and a median of 5 urinations per liter voided. Three definitions of nocturnal polyuria were considered. Nocturnal polyuria was reported by 9% of subjects if the definition was nocturnal urine volume of >35% of the total 24-hour urine volume. When described as nighttime urine production of >0.9 ml/min, 41% of the women could be said to have nocturnal polyuria. If >6.6 ml/kg of urine production was considered to be nocturnal polyuria, this condition was reported by 29% women. Eighteen percent of the subjects had polyuria (total urine output >2500 ml 1 0 ). Linear regression analysis was performed considering all possible confounding variables, including race. Patient age was a statistical significant predictor of total voids per 24 hours (P<.001), number of voids per liter of fluid intake (P <.002), number of nighttime voids (P <.001), and daytime and nighttime diuresis (P <.001 for both). Black women had significantly lower mean urine volume (P <.001), maximum voided volume (P <.001), number of voids per liter of urine output (P <.001), and daytime and nighttime diuresis rates (P <.001 for both). Asian women had significantly higher parity (P =.002), and white women had significantly higher maximum voided volume (P =.002).