Nighttime Voiding Research Articles

Effects of vaccination against COVID-19 on overactive bladder symptoms on young population.

The vaccines developed against COVID-19 have different modes of action, with a primary focus on the spike protein of the virus. Adverse effects following vaccination have been reported, including local and systemic symptoms. Understanding the potential side effects on the urinary tract after vaccination is of importance. Actively investigating and comprehending the potential impact on the urinary tract, we can enhance public health strategies and pave the way for safer and more effective vaccination programs. The study was based on an online survey that included the Spanish Version of the Overactive Bladder Symptom Score (OABSS-S); 2,362 men and women replied to the survey. After the application of the exclusion criteria, 1,563 participants were insured. In the context of COVID-19, individuals were questioned regarding several key factors related to their vaccination status and medical history. These factors included the number of vaccine doses received, the specific type of vaccine administered, whether they had previously contracted COVID-19, and the frequency of prior infections, if applicable. A total of 1,563 (74.7% women and 27.3% men) subjects between the ages of 18 and 45 completed the survey and were included in the final analyses. The most frequently administered vaccine type was Pfizer-BioNTech (42.2%), and most subjects received three doses. The proportion of females who received the AstraZeneca vaccine and do not require to urinate during the night is significantly higher compared to males (59.1% vs. 33.3%; p<0.05). The proportion of individuals who urinate five or more times during the night is higher in those who have received a single vaccine dose than in those who have received three doses (2.2% vs. 0.1%; p<0.05). COVID-19 vaccination has been found to impact the lower urinary tract (LUT) and overactive bladder (OAB). Initially, LUT symptoms worsened, and OABSS-S scores increased after the first vaccine dose in individuals under 45 years old. However, symptoms improved after receiving the third and fourth doses. Gender differences were observed in the vaccination effects. Men vaccinated with AstraZeneca reported a higher number of nighttime voids, while women vaccinated with Moderna reported more daytime voids.

Application of the Sleep C.A.L.M. Tool for Assessing Nocturia in a Large Nationally Representative Cohort.

Nocturia significantly impacts patients' quality of life but remains insufficiently evaluated and treated. The "Sleep C.A.L.M." system categorizes the factors thought to collectively reflect most underlying causes of nocturia (Sleep disorders, Comorbidities, Actions [i.e., modifiable patient behaviors such as excess fluid intake], Lower urinary tract dysfunction, and Medications). The purpose of this study was to assess the association of nocturia with the Sleep C.A.L.M. categories using a nationally representative dataset. Retrospective analysis of the National Health and Nutrition Examination Survey from 2013/14-2017/18 cycles was conducted. Pertinent questionnaire, laboratory, dietary, and physical examination data were used to ascertain the presence of Sleep C.A.L.M. categories in adults ≥20 years of age. Nocturia was defined as ≥2 nighttime voids. A total of 12,274 included subjects were included (51.6% female; median age, 49.0 years [interquartile range, 34.0-62.0 years]; 27.6% nocturia). Among subjects with nocturia, the prevalence of 0, ≥1, and ≥2 Sleep C.A.L.M. categories was 3.5% (95% confidence interval [CI], 2.8%-4.4%), 96.5% (95% CI, 95.6%-97.2%), and 81.2% (95% CI, 78.9%-83.3%), respectively. Compared to those with 0-1 Sleep C.A.L.M. categories, the adjusted odds of nocturia in subjects with 2, 3, and 4-5 Sleep C. A.L.M. categories were 1.77 (95% CI, 1.43-2.21), 2.33 (1.89-2.87), and 3.49 (2.81-4.35), respectively (P<0.001). Similar trends were observed for most age and sex subgroups. When assessed individually, each of the 5 Sleep C.A.L.M. categories were independently associated with greater odds of nocturia, which likewise persisted across multiple age and sex subgroups. Sleep C.A.L.M. burden is associated with increased odds of nocturia in a dose-dependent fashion, and potentially a relevant means by which to organize the underlying etiologies for nocturia among community-dwelling adults.

Étude CamiCon : évaluation d’un nouvel outil pour la réalisation d’un calendrier mictionnel automatisé et connecté

IntroductionA voiding diary (VD) is a key element in the evaluation of patients with overactive bladder (OAB) at initial presentation and during treatment to assess its effectiveness. In order to be clinically relevant, it must be performed over 3 days according to the International Continence Society (ICS). Unfortunately, some patients find it cumbersome. We aimed to evaluate the reliability and patient satisfaction when using a connected tank device. Material and methodWe conducted a single-center prospective study including 41 patients. Each patient completed a paper voiding diary and then a diary with Diary Pod® (DP) or inversely depending on the study arm. Data from 34 patients were collected. After completion of both diaries, patients completed a satisfaction questionnaire sent by email via GoogleForm. Study statistics were performed with Jamovi® and Excel® software. ResultData from 34 patients were analyzed. There was a statically significant difference (P=0.046) between the mean volume calculated from the paper VD and that calculated from the connected VD (DP). There was no statistically significant difference (P=0.112) between the mean number of daytime voids, mean number of nighttime voids (P=0.156), mean water intake (P=0.183) reported on the paper VD and the connected VD. Thirteen (42%) paper VD and 1 connected VD did not include documentation of the presence or absence of urine leakage or urgency. There was no statistically significant difference between the two calendars regarding the presence or absence of urine leakage (P=0.180) and urinary urgency (P=0.564). Eighty-four percent (26/31) preferred the connected tank to the usual method (paper/pen), while 55% (17/31) and 29% (9/31) of the participants respectively answered that the DP was “very definitely” or “definitely” an aid for performing VD. Nevertheless, 39% (12/31) and 55% (17/31) considered its price to be high or fair and only 22% (7/31) were inclined to buy it. ConclusionThis study showed that the Diary connected reservoir Pod® is a reliable and innovative tool for voiding schedules. It facilitates data collection for the majority of patients (83%) and could, through better patient compliance, provide better quality data and help their interpretation by the physician. These factors could encourage the implementation of the connected voiding diary as a diagnostic tool. It would also be used for the assessment of treatment effectiveness in daily clinical practice as well as in research. Its cost remains a major obstacle, judged by 39% of patients to be too high, and could therefore be proposed in specific situations requiring precise data.

Real-World Evidence for Risk Factors of Bruises and Fractures from Falls in Patients with Overactive Bladder: A Medical Record Analysis.

To identify the risk factors for bruises and fractures from falls in patients with overactive bladder (OAB). We evaluated 1136 patients with OAB and aged ≥50 years who visited our hospital. Age, sex, frequency of nocturnal urination, and urinary incontinence type were investigated in the 360 eligible patients. Patients were divided into three groups: those patients without falls (no-fall group), those with fall bruises (bruise group), and those with fall fractures (fracture group). The risk factors for bruises and fractures in patients with OAB were evaluated using the logistic regression analysis. In addition, association between the bruises or fractures from falls and the behavior around urination during the night was investigated. The multivariate logistic regression analysis showed that female sex (odds ratio (OR) 2.888, p = 0.030) and nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.940; p = 0.040) were significantly associated with bruises. Nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.835; p = 0.026) and urge incontinence (OR 3.415, p = 0.016) were significantly associated with fractures. Behavior around urination during the night was significantly associated with fractures (p = 0.009). In the real-world clinical setting, increasing nocturnal urination frequency is a common risk factor for bruises and fractures. Also, female sex and urge incontinence were the risk factors for bruises and fractures, respectively. OAB patients with urge incontinence would especially require aggressive intervention to prevent fractures during night-time voiding.

Neutrophil-to-lymphocyte ratio as a promising non-invasive biomarker for symptom assessment and diagnosis of interstitial cystitis/bladder pain syndrome

BackgroundOur study aims to investigate the association between the serum neutrophil-to-lymphocyte ratio (NLR) and interstitial cystitis (IC), as well as to explore whether NLR can serve as a diagnostic marker to distinguish IC from overactive bladder (OAB). We postulate that elevated NLR levels are intricately linked to the onset and clinical presentation of IC, and that the NLR profiles in OAB patients exhibit discernible disparities from those of IC patients.MethodsIn a retrospective analysis, we scrutinized the medical records of 70 women diagnosed with IC/BPS, 20 women diagnosed with OAB, and a randomly selected cohort of 150 healthy women who underwent physical examinations during the same temporal frame. A comprehensive panel of blood tests was administered to all participants, and NLR was determined through the calculation of the neutrophil-to-lymphocyte proportion. Additionally, symptom assessment questionnaires and urination diaries were collected from IC/BPS patients.ResultsNLR levels exhibited significant distinctions among the IC/BPS, Normal, and OAB groups (P < 0.001). Within the IC/BPS group, Hunner type interstitial cystitis (HIC) demonstrated notably divergent NLR levels in comparison to non-Hunner type interstitial cystitis (NHIC) (p = 0.001). Additionally, we observed positive correlations between NLR and Nighttime voids (r = 0.268, p = 0.029), ICPI (r = 0.327, p = 0.007), ICSI (r = 0.369, p = 0.002), PUF Symptom Scale (r = 0.263, p = 0.032), and PUF (r = 0.297, p = 0.015). The receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.765 for NLR in distinguishing IC/BPS from the Normal group, and an AUC of 0.707 in discerning IC from OAB. Furthermore, the AUC of NLR was 0.723 for identifying HIC and NHIC patients.ConclusionsOur study unveils the prospective utility of serum NLR as a promising biomarker for both diagnostic and symptom evaluation purposes in IC/BPS patients. It effectively demarcates this condition from OAB, which presents with similar clinical features. Consequently, NLR demonstrates potential as a non-invasive diagnostic instrument to distinguish between the subtypes of IC, particularly HIC and NHIC, which manifest similar symptoms within the IC/BPS spectrum.

Sleep Quality Assessment in Correlation to Autonomic Nerve Function in Type 2 Diabetic Patients

Background and Objective Diabetes mellitus negatively impacts the quality of life of its patients. Autonomic dysfunction may disturb sleep quality by negatively affecting multiple systems, including, but not limited to, the cardiovascular, respiratory, and genitourinary tracts. The current study aims to assess sleep quality and examine the degree of correlation with autonomic nervous function in relatively well-controlled type 2 diabetic patients.Methods This study uses a cross-sectional design to assess sleep quality in 88 type 2 diabetic patients via the Pittsburg Sleep Quality Index (PSQI), accordingly dividing them into two groups: good or poor sleepers. Subsequently, the study evaluates autonomic nerves’ conductivity by measuring electrical skin conductance using Sudoscan for the hands and feet.Results Of 88 recruited patients, 53% showed poor sleep quality, with higher incidence in females. Autonomic nerve conductivity showed moderate damage in poor sleepers with 59.53 ± 13.35 μS and 59.68 ± 16.91 μS of hand and foot electrodes, respectively. Autonomic damage induces sleep disturbance mainly through increased nighttime voiding in 91.49% of the poor sleepers group compared to 41.46% in the good sleepers group. PSQI score was found to strongly and inversely correlate with autonomic nerve conductivity via hand electrodes, with a correlation coefficient of -0.62 and a determination coefficient of 0.39.Conclusion Poor sleep quality seems to be a significant problem even in relatively well-controlled type 2 diabetic patients with no diagnosed micro- or macrovascular complications. Autonomic dysfunction negatively affects the quality of sleep and leads to sleep disturbance by increasing nighttime micturition as one of its complications.

MP03-09 PHENOTYPING NOCTURIA IN HYPERTENSIVES ACCORDING TO 24-HOUR URINE COMPOSITION

You have accessJournal of UrologyCME1 Apr 2023MP03-09 PHENOTYPING NOCTURIA IN HYPERTENSIVES ACCORDING TO 24-HOUR URINE COMPOSITION Joseph Boroda, Susan Gong, Frederick Okoye, Syed Rahman, Matthew Moy, Alla Akivis, Jason Lazar, and Jeffrey Weiss Joseph BorodaJoseph Boroda More articles by this author , Susan GongSusan Gong More articles by this author , Frederick OkoyeFrederick Okoye More articles by this author , Syed RahmanSyed Rahman More articles by this author , Matthew MoyMatthew Moy More articles by this author , Alla AkivisAlla Akivis More articles by this author , Jason LazarJason Lazar More articles by this author , and Jeffrey WeissJeffrey Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are numerous comorbidities correlated with nocturia, among the most clinically significant of these being hypertension. Elevation in blood pressure (BP) suppresses serum arginine vasopressin levels, lending evidence to the idea that hypertension is associated pathophysiologically with nocturnal polyuria, which may cause nocturia. Greater nighttime BP and lower nocturnal BP dipping have been associated with more frequent nocturnal voiding. The aim of this study is to assess the impact of non-dipping orthostatic BP in hypertensives on nighttime and daytime urine production. METHODS: Participants with a diagnosis of essential hypertension had in-office supine and standing BP recordings and completed 24-hour urine collection and voiding diaries. Urine was collected in 3 containers; one for the first nighttime void, a second for all subsequent nighttime voids and first morning void, and a third for all daytime voids. Participants whose systolic BP decreased with supine positioning were placed in the orthostatic dip group, and participants whose systolic BP increased or was unchanged upon supine positioning were placed in the no orthostatic dip group. RESULTS: There were 12 (9 female) individuals in the dipping group and 19 (13 female) in the non-dipping group. The non-dipping group tended to produce greater volumes of urine both day and night, and had greater 24-hour urine sodium excretion. The sodium concentration of the first nighttime void was significantly higher in the non-dipping group (median: 102; IQR: 76-105 mEq/L) than the dipping group (median: 51; IQR: 32.5 - 65 mEq/L) (p=.024). This urine sodium concentration for the remainder of the night was significantly higher in the non-dipping group (median: 92; IQR: 62-117 mEq/L) than the dipping group (median: 59.5; IQR: 48-77.25 mEq/L) (p=.012). Subjects in the non-dipping group were 79% more likely to experience 2 or more nighttime voids compared to the dipping group (RR: 1.79; 95% CI: 1 – 3.2; p=.052). CONCLUSIONS: An in-office BP measurement that does not dip with supine positioning is associated with more frequent nighttime voiding as well as higher urine concentrations of sodium in both early and late-night voids. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e24 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Boroda More articles by this author Susan Gong More articles by this author Frederick Okoye More articles by this author Syed Rahman More articles by this author Matthew Moy More articles by this author Alla Akivis More articles by this author Jason Lazar More articles by this author Jeffrey Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

Evening home blood pressure and pulse rate: age-specific associations with nocturia severity.

Previous studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology associated with pulse rate (PR) remains unclear. In the Japan Morning Surge-Home Blood Pressure Study, a self-administered nocturia questionnaire and evening home blood pressure (BP) and PR measurements (taken on a mean of 11.2 days) were performed on 4310 patients with one or more cardiovascular risk factors (mean: 64.9 years old; 47% male). According to the number of nighttime voids, the study population was divided into three groups (no voids: n = 2382; 1 void: n = 847; ≥2 voids per night: n = 1082). In the multinomial logistic regression analysis adjusted for confounders, diuretic use (OR, 1.23; 95%CI, 1.01-1.50; p < 0.05) was significantly associated with one nocturnal void, whereas evening home systolic BP (SBP) (OR per 1 SD, 1.14; 95%CI, 1.05-1.24; p < 0.01) and evening home PR (OR per 1 SD, 1.12; 95%CI: 1.02-1.24; p < 0.05) were significantly associated with multiple nocturnal voids. In the younger group (<65 years), only evening home PR was significantly related to multiple nighttime voids (p < 0.01), whereas in the older group (≥65 years), only evening home SBP was significantly related to multiple nighttime voids (p = 0.02). In this study, both higher evening home PR and higher evening home SBP were associated with multiple nighttime voids, with the former playing a greater role in the younger participants, and the latter more often associating the older group. An age-stratified approach to reduce the burden of BP or PR might be important to improve sleep quality.

Impact of delivery method and fetal size on nocturia: An analysis of the national health and nutrition examination survey

Purpose:Pregnancy has been associated with long-term lower urinary tract symptoms such as nocturia. The purpose of this study was to explore potential associations between delivery modality and fetal size during pregnancy and the presence of nocturia. Materials and Methods:Using the National Health and Nutrition Examination Survey (NHANES) database from 2005/06-2017/18, we categorized females by status of prior delivery modalities: nulligravida, vaginal deliveries, and cesarean deliveries. Groups were weighed and case-control matched for age, race, BMI, and number of deliveries. The association of delivery modality and fetal size (≥9 pounds or <5.5 pounds) on odds of nocturia and mean number of nighttime voids was assessed. Results:Of the 1324 females analyzed (age range 20–49 years), 378 were nulligravida, 473 had vaginal deliveries, and 473 had Cesarean deliveries. Prevalence of nocturia was 18.3% for nulligravida, 24.1% for vaginal deliveries, and 24.1% for Cesarean deliveries subgroups. Both a history of vaginal deliveries (OR = 1.42, p = 0.039) and Cesarean deliveries (OR = 1.42, p = 0.039) showed an association to nocturia, although no differences were seen between the two groups. Number of deliveries or fetal size did not show any associations to nocturia development nor differences in mean number of nighttime voids in comparing the subgroups. Conclusions:While both delivery modalities were associated with nocturia, the relationship does not differ between vaginal or Cesarean deliveries. No differences in nocturia were seen when the delivery modality groups were further sub-grouped by number of deliveries and fetal size.

Urinary Incontinence and Sleep Quality in Older Women with Type 2 Diabetes: A Cross-Sectional Study.

Urinary incontinence (UI) and poor sleep negatively affect health-related quality of life (HRQoL). This study explored the UI-related factors and the relationships between UI, sleep quality, and HRQoL. This cross-sectional study collected data from 237 women with type 2 diabetes. Multivariate logistic regression was conducted to identify the factors associated with UI. One-way analysis of variance was used to compare the mean sleep quality and HRQoL scores of women without UI and those who experienced UI of varying severities. Correlation coefficients were estimated, and multivariate linear regression was conducted to examine the relationships between UI severity, sleep quality, and HRQoL. Of the 237 women, 115 (48.52%) experienced UI and 139 (58.65%) were poor sleepers. The three factors associated with UI were advanced age, a higher body mass index, and a history of vaginal delivery. Significant associations between UI severity and sleep quality and between sleep quality and HRQoL were revealed. UI severity and night-time voiding frequency were both associated with sleep quality. One factor associated with UI (body mass index) is modifiable. UI severity is associated with sleep quality as the possible influence of night-time voiding frequency on sleep quality has been considered.

Predictive Values of Nocturia and Its Voiding Frequency on the Aging Males' Symptoms.

Background: The link between nocturia and aging male symptoms (AMS) has not been scientifically established. This study aimed to measure the degree of severity of AMS that impacts health-related quality of life (HRQoL) in adult males living with nocturia and to determine the predictive values of nocturnal factors on AMS. Methods: This is an extended analysis of new data collected by using the Hong Kong Traditional AMS (HK-AMS) scale and the Cantonese version of the Pittsburgh Sleep Quality Index (PSQI) in a recently published cross-sectional population-based survey. Results: Of the 781 respondents that completed the set of questionnaires, 68% and 61% of men living with nocturia reported clinically significant (at moderate-to-severe levels) somato-vegetative and sexual AMS; the prevalence and severity were increased with advancing nighttime voiding frequency. Age, the Global PSQI score, certain metabolic diseases, the nocturia-specific QoL (NQoL) score and bedtime voiding frequency were found to be significant predictive factors for composite somato-vegetative and sexual AMS. Conclusions: The current findings suggested the inclusion of nocturia when measuring male-specific HRQoL related to aging.

Association between pregnancy and nocturia: A National Health and Nutrition Examination Survey analysis.

This study aimed to determine the impact of pregnancy and pregnancy-associated characteristics on nocturia. Using the National Health and Nutrition Examination Survey (NHANES) database from 2005/06 to 2017/18, we analyzed women who completed the "Reproductive Health" and "Kidney Conditions-Urology" questionnaires by sorting them into three groups: nulligravida, previously pregnant (nonpregnant with prior pregnancies), and currently pregnant. After excluding patients with pre-existing conditions impacting nocturia or with incomplete data, we weighed and matched the groups for age, race, BMI, and number of pregnancies. The relationships of nocturia to pregnancy in all groups and pregnancy-associated characteristics (gestational diabetesmellitus[GDM], history of multiple pregnancies, and trimesters of pregnancy) in currently pregnant women were assessed. Of 8330 women that indicated pregnancy status, 1544 women (age range: 20-44 years; 523 nulligravida, 498 previously pregnant, 523 currently pregnant women) were included in analysis. Currently, pregnant women had a higher prevalence of nocturia than previously pregnant and nulligravida women (56.4% vs. 22.5% vs. 16.1%, p < 0.001) and had the highest odds of nocturia (OR: 6.82, p < 0.001). GDM or history of multiple pregnancies showed no associations in currently pregnant women. Increasing trimesters were associated with nocturia, with the third trimester showing the highest odds (OR: 10.35, p < 0.001) and a greater average of nighttime voids than the first and second trimesters (2.40 ± 1.42 vs. 1.56 ± 1.31 and 1.88 ± 1.32, p < 0.001). The association noted between pregnancy and nocturia, which strengthened with increasing trimesters, demonstrates that nocturia can significantly impact quality of life and therefore must be addressed during pregnancy.

MP18-01 THE EFFECT OF AGING ON URINE NATRIURETIC PEPTIDES IN NOCTURIA AND NOCTURNAL POLYURIA

You have accessJournal of UrologyCME1 May 2022MP18-01 THE EFFECT OF AGING ON URINE NATRIURETIC PEPTIDES IN NOCTURIA AND NOCTURNAL POLYURIA Lakshay Khosla, Joseph U. Boroda, Joshua Salama, Syed N. Rahman, Danielle J. Gordon, Matthew W. Moy, Yonatan Akivis, Alla Akivis, Jason M. Lazar, Jeffrey P. Weiss, and Lori A. Birder Lakshay KhoslaLakshay Khosla More articles by this author , Joseph U. BorodaJoseph U. Boroda More articles by this author , Joshua SalamaJoshua Salama More articles by this author , Syed N. RahmanSyed N. Rahman More articles by this author , Danielle J. GordonDanielle J. Gordon More articles by this author , Matthew W. MoyMatthew W. Moy More articles by this author , Yonatan AkivisYonatan Akivis More articles by this author , Alla AkivisAlla Akivis More articles by this author , Jason M. LazarJason M. Lazar More articles by this author , Jeffrey P. WeissJeffrey P. Weiss More articles by this author , and Lori A. BirderLori A. Birder More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hormones involved in water homeostasis may impact the pathophysiology of age-related nocturia and nocturnal polyuria (NP). The purpose of this study was to analyze the effect of aging on urine natriuretic peptides in nocturia and NP. METHODS: Patients aged ≥18 years were recruited from 2019 to 2021 to complete bladder diaries for assessment of nocturia, defined as ≥2 nighttime voids, and NP, defined as nocturnal urine volume divided by 24-hour urine volume, or NP index (NPi), >0.33. Patients were excluded if they had characteristics that influence nocturia. They were divided into subgroups of <65 years old and ≥65 years old. Urine samples were analyzed for natriuretic peptide fragments (NT-proANP, NT-proBNP, and NT-proCNP). The Kruskal-Wallis H and Mann-Whitney U tests were used to compare patients stratified by status of nocturia/NP and age subgroups. Spearman’s rank order correlation was used to analyze correlations between NPi and urine natriuretic peptides. RESULTS: Compared to patients without nocturia (n=15; median ± IQR, 64.0±13.8 years), those with nocturia (n=36; 68.0±8.0 years) had significantly higher urine NT-proANP (86.0 vs 50.2 pmol/L, p=0.012) and NT-proBNP (33.1 vs 17.9 pmol/L, p=0.017), but showed no differences in NT-proCNP (11.4 vs 11.8 pmol/L, p=0.702). Patients with NP (n=30) had higher NT-proANP (96.2 vs 45.5 pmol/L, p<0.001) and NT-proBNP (34.9 vs 20.2 pmol/L, p=0.014), but showed no differences in NT-proCNP (11.8 vs 11.7, p=0.962) compared to those without NP (n=21). Compared to patients <65 years old with nocturia or NP, patients ≥65 years old with nocturia or NP had higher NT-proANP and NT-proBNP (Table 1). NPi positively correlated with NT-proANP (RS=0.416, p=0.002) and NT-proBNP (RS=0.328, p=0.019), but not with NT-proCNP (RS=-0.029, p=0.840). CONCLUSIONS: Age-related nocturia may in part be explained by natriuretic peptides, since aged patients with nocturia had greater urine NT-proANP and NT-proBNP. To understand hormonal changes in the mechanisms of age-related nocturia, future work should look to analyze these effects in controlled settings and exploit the differences to determine potential treatment pathways for nocturia management. Source of Funding: This study was supported by the Ferdinand C. Valentine Medical Student Research Grant in Urology from The New York Academy of Medicine awarded to LK © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e295 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lakshay Khosla More articles by this author Joseph U. Boroda More articles by this author Joshua Salama More articles by this author Syed N. Rahman More articles by this author Danielle J. Gordon More articles by this author Matthew W. Moy More articles by this author Yonatan Akivis More articles by this author Alla Akivis More articles by this author Jason M. Lazar More articles by this author Jeffrey P. Weiss More articles by this author Lori A. Birder More articles by this author Expand All Advertisement PDF DownloadLoading ...

Differences in the Prevalence of Nocturnal Polyuria in the U.S. by Definition: Results from the Epidemiology of Nocturnal Polyuria Study.

Prevalence data on nocturnal polyuria (NP), nocturia caused by overproduction of urine during sleep, is primarily limited to men and varies by NP definition. This U.S.-representative epidemiological study of men and women ≥30 years old assessed the prevalence of NP. Consenting participants completed the baseline EpiNP (Epidemiology of Nocturnal Polyuria) survey (eg Lower Urinary Tract Symptoms Tool, comorbidities). All reporting ≥2 voids/night and a target of 100 random respondents reporting 0 or 1 void/night were asked to complete 3-day bladder diaries. NP was defined as nocturnal polyuria index (NPI) >0.33 (NPI33) and nocturnal urine production >90 ml/hour (NUP90). Extrapolated prevalence was stratified by sex and subgroups: idiopathic (without underlying causes), associated with overactive bladder (NPOAB), bladder outlet obstruction (NPBOO; men) and comorbidities. Voided volumes and timing, including first uninterrupted sleep period, were assessed by subgroup. A total of 10,190 individuals completed the baseline survey; mean age (range) was 54.4 (30-95). A total of 3,938 individuals were invited to complete the diary; 1,763 (49.3%) completed 3-day bladder diaries. Urine production (maximum nighttime volume, total volume, nocturnal urine production, nocturia index) was higher in both men and women with idiopathic NP and comorbidities. The median number of nighttime voids was greatest for NPBOO in men and NPOAB in women. Bother associated with nighttime voiding differed by NP subgroup but was highest in NPBOO for men (NPI33: 69.6%; NUP90: 71.1%) and NPOAB for women (NPI33: 67.5%; NUP90: 66.0%). This population-based NP prevalence study including men and women characterizes NP subgroups and provides insights into nocturia treatment by emphasizing factors influencing urine production versus factors influencing bladder capacity.

Efficacy of percutaneous and transcutaneous posterior tibial nerve stimulation on idiopathic overactive bladder and interstitial cystitis/painful bladder syndrome: A systematic review and meta-analysis.

Percutaneous and transcutaneous posterior tibial nerve stimulation (PTNS and TTNS) showed a promising effect on overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome. We aimed to give a systematic review and meta-analysis on the efficacy and safety of these therapeutic methods as well. We searched studies available on PubMed, Embase, Cochrane, Scopus, Web of Science, and ProQuest on March 31, 2021, to find both published and unpublished studies. The retrieved articles were screened by two independent researchers and then the selected studieswere critically appraised by Cochrane risk-of-bias tool for randomized trials, and Joanna Briggs Institute'schecklist for quasi-experimental studies. Finally, the results of studies were synthesized using Review Manager (RevMan) 5.4 statistical software when the data were homogenous. The meta-analysis was performed by calculating the effect size (mean difference) and their 95% confidence intervals (CIs). Of the total 3194 publications, 68 studies were included in our qualitative evaluationand 9 studies (11 trials) in the quantitative stage. When TTNS or PTNS were compared to sham, placebo, no treatment, or conservative management, a decrease in frequency of urination was observed in both TTNS (mean difference [MD]: -3.18, 95% CI: -4.42 to -1.94, and p < 0.00001), and PTNS (MD: -2.84, 95% CI: -4.22 to -1.45, and p < 0.00001), and overall TTNS or PTNS (MD: -2.95, 95% CI: -4.01 to -1.88, and p < 0.00001). Significant improvements in mean voiding volume (MVV) and decreasing nocturia were also observed. Nerve stimulations either PTNS or TTNS appear to be effective interventions in treating refractory idiopathic OAB in terms of daily voiding frequency, MVV, urgency episodes, and nighttime voiding frequency. However, our result did not show any improvement in terms of urinary incontinence, postvoid residual volume or urge incontinence, and maximum cystometric capacity which emphasized the efficacy of these modalities on dry-OAB rather than wet-OAB.

A Simple Algorithm to Facilitate Improved Diagnosis of Nocturia

Introduction/Aim: Traditionally, nocturia is considered a bothersome storage symptom, associated with prostatic enlargement. However, nocturia occurs also in a range of urological and non-urological conditions. Some other authors consider nocturia as a disease rather than a symptom. The aim of this article is to present the clinically relevant features of nocturia and to suggest a simple algorithm to facilitate its investigation. Material and Methods: A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, PubMed, EMBASE, the Cochrane Library and other libraries using the key words “nocturia”, “nocturnal frequency”, “nighttime voiding”, in various combinations with the terms “etiology”, “pathophysiology” “risk factors”, “causes”. We included reviews metanalyses and clinical studies. We considered full-text written papers. Bibliographic information in the selected publications was checked for relevant records not included in the initial search. Results: According to current litterature is a very common condition that affects millions of people worldwide. The rate of people affected increases with age. About 1 in 3 adults over the age of 30 experience nocturia. There is a predominance of female gender among younger patients however occurrence of nocturia is equal between men and women aged 50-59 years. Nocturia occurs in more than 50% of individuals over 60 years of age and the prevalence is greater in men than women. The impact of nocturia in overall health is highly significant. Additionally, to the decrease in quality of life due to the inconvenience that it causes, nocturia can be associated with long-term sleep deprivation and the subsequent exhaustion, mood changes, somnolence, impaired productivity, increased risk of falls and accidents, fatigue, lethargy, inattentiveness, and cognitive dysfunction. Despite its high frequency and significance, nocturia remains under-reported, and under-treated. The most usual reasons explaining the above is the variety of contributing factors and conditions. Conclusions: It is paramount that clinicians are aware of the multiple potential contributing factors in any given patient. A simplified algorithm may help to identify the underlying etiology (such as diabetes or nocturnal polyuria) leading to better treatment outcomes, improved quality of life scores, and substantial symptom resolution.

Psychometric validation and interpretation of the Nocturia Impact Diary in a clinical trial setting

PurposePsychometric evaluation of the Nocturia Impact (NI) Diary was conducted to support its use as a trial endpoint.MethodsAs part of a randomized, controlled Phase 2 clinical trial investigating a novel drug candidate for nocturnal polyuria, adult nocturia patients completed the NI Diary and a voiding diary for three nights preceding their clinic visit at Baseline and Weeks 1, 4, 8, and 12 (end of treatment). Exit interviews were conducted to obtain patient impressions of the NI Diary.ResultsA total of N = 302 participants were included. Confirmatory factor analysis (CFA) indicated that the 11-item measure is unidimensional with values of CFI, TLI, and RMSEA meeting relevant thresholds. Good internal consistency (Cronbach’s α 0.941) and test–retest reliability (intra-class correlation coefficients 0.730–0.880). Convergent validity with two reference measures was demonstrated with strong correlations of 0.573–0.730 were shown. Significant differences (P = 0.0018, standardized effect size = 0.372) between groups defined by number of night-time voids supported known-groups validity. Exit interviews in 66 patients indicated all participants experienced improvement in at least 1 NI Diary item and that a 1-point improvement on the item response scale and 1-void reduction per night (associated with an average best cut point on ROC analysis of − 11.6) constituted meaningful improvement. Anchor and distribution-based analyses identified a meaningful change threshold of − 15 to − 18 points on the NI Diary.ConclusionThe NI Diary is a reliable and valid patient-reported psychometric instrument which is fit-for-purpose to evaluate the impact of nocturia on patient quality of life in the clinical trial setting.Trial registration number and registration date NCT03201419; June 28, 2017.

Effects of Additional Glycine in Outpatients Being Treated for Urine Storage Disorders

Objectives: This study aimed to determine whether additional glycine can improve urine storage symptoms in outpatients. Methods: We recruited 50 outpatients (15 females, 35 males) with an Overactive Bladder Symptom Score (OABSS) of 3 or more. Participants being treated for urine storage disorders took additional glycine for 8 weeks at a dose of 3 g twice a day. Outcome measures included blood pressure, the International Prostate Symptom Score (IPSS), OABSS, Nocturia Quality of Life (N-QOL) score, urination frequency, sleep latency, time until the first void at night, bladder pain, improvement in urinary symptoms assessed with the Global Self-Assessment (GSA), and adverse events. Results: In the OABSS, the number of nighttime voids, urgency to urinate, urgent incontinence, and total score were improved. Improvements were also found in the IPSS total score for urine storage items, blood pressure, IPSS-QOL, time to first void, bladder pain, and GSA score, but no changes were seen in the frequency of urination at night, sleep latency or N-QOL score. No adverse events were recorded. Conclusion: Oral glycine improves objective and self-assessed urine storage symptoms, blood pressure, and bladder pain.

Monocentric single-arm study of desmopressin acetate efficacy on nocturnal polyuria in the elderly.

We designed a retrospective, monocentric, observational study to assess the efficacy and short-term side effect profile of desmopressin, a synthetic analogue of antidiuretic hormone, in 42 elderly patients affected by nocturnal polyuria (NP), a subset of nocturia (nocturnal overproduction of urine at night), which is characterised by nocturnal urine volume (NVU) exceeding 33% of the 24-hours total urine output. The subjects had NP and included 25 males, which had benign prostatic hyperplasia (12 out of 25 had been surgically or endoscopically operated) and 15 females that had increased urinary frequency, night-time voiding, loss of bladder control and recurrent bladder infections, due to perineal wall weakness and vaginal or bladder prolapse. Patients recorded the number of voids during waking hours using a digital continuous urine meter. The quality of life (QoL) and efficacy of desmopressin were assessed at baseline and 12 weeks after treatment using the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol) and International Prostate Symptom Score questionnaire (IPPS-Q8). The dosage of desmopressin acetate varied according to the discretion of the physician, usually beginning with one tablet before going to bed at night for 3 months. The dose was increased at 1-week intervals if a reduction in the NVU or night-time frequency was not achieved. We found that desmopressin treatment reduced the nocturnal voided volume (P < .0001), ICIQ-Nqol (P < .0001) and IPPS-Q8 (P < .0001). No significant serum sodium alterations or modifications in serum creatine, potassium, or body weight were observed in all the patients. No adverse effects were observed. Our findings show efficacy of desmopressin in the elderly for NP treatment supporting further clinical trials in larger cohorts of patients.

Characterizing nocturia among Belgian healthy postmenopausal women: Prevalence, degree of bother, etiology and risk factors for nocturia

IntroductionLimited literature concerning nocturia in early postmenopausal women is available. However, due to the lack of endogenous estrogen in these women, an increased prevalence of nocturia is expected. Material and methodsThis prospective observational trial recruited 210 ‘early’ postmenopausal women consulting the Ghent University menopause clinic. Postmenopausal status was biochemically confirmed. Women completed 3 questionnaires: the ICI questionnaire on nocturia (ICIQ-N); ‘Targeting the individual’s Aetiology of Nocturia to Guide Outcomes’ (TANGO) and the Perceived Stress Scale (PSS). Moreover, information concerning women’s age, anthropometrics and lifestyle was collected. Nocturia was defined as two or more nocturnal voids. ResultsNocturia was reported in 24.8% (52/210) of the postmenopausal women. Bother increased with every nocturnal void. Women with two or more nighttime voids were found to have significantly increased prevalence of urgency compared with women with only one (p < 0.001; 38.5% versus 22.7%). Trouble initiating sleep at the start of the night and insomnia during the night were significantly different in women with a different nocturnal frequency (initiating sleep p = 0.09, no voids 34.4 %, 1 void 39.2 %, ≥ 2 voids 53.8 %; insomnia p < 0.001; no voids 1.6%, 1 void 22.7 %, ≥ 2 voids 53.8 %). In addition to bladder and sleep dysfunctions, waist circumference was a risk factor for nocturia (OR 1.04; 95 % CI: 1.01–1.08). ConclusionNocturia is an important problem in early postmenopausal women, affecting a quarter of the questioned women. Etiology of nocturia in this population is multifactorial as estrogen withdrawal is accompanied by bladder and sleep dysfunctions.