Nocturia Episodes Research Articles

Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort

IntroductionThis study aimed to assess the outcomes of mirabegron for the treatment of overactive bladder (OAB) symptoms in patients with Parkinson disease (PD). MethodsA retrospective study was conducted including patients with PD who received mirabegron 50 mg once daily for OAB symptoms between 2012 and 2017. The primary endpoint was clinical success defined as any improvement in overactive bladder symptoms self-assessed by the patients 6 weeks after mirabegron initiation. Secondary endpoints included number of pads per day, number of nocturia episodes and adverse events. ResultsFifty patients (mean 74 years old) were included. Before being treated with mirabegron, 56% had failed prior anticholinergic therapy. After 6 weeks of mirabegron 50 mg, five patients (11.4%) had a complete resolution of their OAB symptoms; 25 patients (50%) reported improvement, 23 (46%) reported no change and 2(4%) reported worsening of their OAB symptoms. The number of pads per day decreased from 1.5 to 0.9 (p = 0.01) and so did the number of nocturia episodes (from 3 to 2.6/night; p = 0.02). Only 2 adverse events were reported during mirabegron treatment (4%): one dizziness and one diaphoresis, that disappeared after mirabegron discontinuation. After a median follow-up of 19 months, 23 patients (46%) persisted on mirabegron. Persistence rates were 51.5%, 44.6% and 36.4% at 1, 2 and 3 years respectively. ConclusionMirabegron has an excellent safety profile and appears to be an effective treatment for overactive bladder symptoms in patients with PD. Further prospective randomized trials are needed to properly assess mirabegron in PD patients.

149 Nocturia is Significantly Associated with Depressive Symptoms in Caucasian-European Men Seeking Medical Help for Sexual Dysfunction Without Known Psychiatric Disorders

We aimed to investigate the association between nocturia and mood impairment in a homogeneous cohort of Caucasian-European men seeking medical help for solitary erectile dysfunction (ED) as a primary reason for office evaluation, without any known psychiatric disorders. Data from 426 patients with ED were analysed. Patients completed the Beck’s inventory for Depression (BDI), the International Index of Erectile Function (IIEF) and the International Prostatic Symptoms Score (IPSS). Depressive symptoms (DS) were considered for BDI≥11, with clinical depression (CD) defined as a BDI score ≥16. Nocturia was defined as ≥2 nocturnal voiding episodes. The number of nocturia episodes was assessed using IPSS question 7. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Testosterone deficiency (TD) was defined as tT <3.5 ng/mL. Descriptive statistics and logistic regression models tested the association between nocturia and DS and/or CD. Overall, mean (SD) age was 47.6 (14.1) yrs and mean tT value was 4.9 (2.9) ng/mL; TD was observed in 90 (21.2%) patients. Mean BDI was 7.23 (7.2); BDI scores suggestive for DS and CD were observed in 107 (25.1%) and 51 (12.0%) patients, respectively. Of all, 66 (15.6%), 59 (13.9%), 69 (16.1%) and 133 (31.2%) men had mild, mild-to-moderate, moderate and severe ED, respectively. Nocturia was reported in 150 (35.2%) men. Patients with nocturia showed higher rate of obesity (p=0.02), BDI scores suggestive for either DS (31.3% vs. 21.7%; p=0.029) or CD (18.7% vs. 8.3%; p=0.002) compared to patients without nocturia. No differences in terms of age, CCI, IIEF-EF and TD prevalence were observed between the two groups. At multivariable analysis, BMI (p=0.015), CCI (p=0.015), low IIEF-EF score (p=0.03) and nocturia (p=0.024) achieved independent predictor status for DS, after accounting for age and testosterone values. Conversely, only age (p=0.04), low IIEF-EF score (p=0.04) and nocturia (p=0.016) achieved independent predictor status for CD.

The Degree of Bother of Nocturea on Quality Of Life in a Group from Al-Diwaniya Population.

Nocturia is common and disrupts sleep. Traditionally,one nightly episode has been regarded as clinically meaningless.To evaluate the bothersome effect of nocturia on health related quality of life (HRQoL) in a group from Al-Diwaniya population. Patients and methods: In 2006–2008,a survey was made on a random sample of 600 patients aged 18–79 yr who were identified from Al-Diwaniya teaching hospital,proportion was 62% males and 38% were females).bother from nocturia on QoL were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Score). Bother from nocturia was assessed on a four-point scale (none,small,moderate,major). Degree of bother increased with nocturia frequency (p &lt; 0.01). The most commonly cited degree of bother for those with one,two,and three nightly voids was no bother,small bother,and moderate bother,respectively. At least two voids per night are bothersome and associated with impaired HRQoL. The majority of people report having bothered when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and,thus,is not a suitable criterion for clinically relevant nocturia.

MP79-15 RISK FACTORS FOR NOCTURNAL POLYURIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2018MP79-15 RISK FACTORS FOR NOCTURNAL POLYURIA Harjot Singh, Jeffrey Weiss, Jerry Blaivas, Linda Dayan, and Noam Fine Harjot SinghHarjot Singh More articles by this author , Jeffrey WeissJeffrey Weiss More articles by this author , Jerry BlaivasJerry Blaivas More articles by this author , Linda DayanLinda Dayan More articles by this author , and Noam FineNoam Fine More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2683AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to determine the prevalence of potential risk factors for nocturnal polyuria in patients with lower urinary tract symptoms (LUTS). METHODS This is a retrospective study of patients who completed the lower urinary tract symptom score (LUTSS) and at least one 24 hour bladder diary (24 HBD) during an evaluation of LUTS. The patients were divided into two groups based on the Nocturnal Polyuria Index (NPi): nocturnal polyuria (NP+) defined as an NPi >0.33 and normal nocturnal urine production (NP-) defined as an NPi <0.33. History, surgeries and medications were recorded. Binary logistic regression was performed to find the relations between potential risk factors and diary parameters with nocturnal polyuria. Values for general population prevalence were taken from the literature. RESULTS There were 524 patients, 338 males and 186 females (age range=12-99), 90% completed a LUTSS questionnaire. The mean age of NP+ and NP- groups were 71.5 (standard deviation=13.9) and 60 (SD=17.4), respectively (p<0.0001). Of the 145 NP+ patients, 96 (66%) were males and 49 (34%) were females (p<0.005). Of 379 NP- patients, 242 (64%) were males and 137 (36%) were females (p<0.005). The mean total number of voids for NP+ and NP- groups were 11.9 and 10.6, respectively (p<0.003), and the mean number of nocturnal voids of NP+ and NP- groups were 3.5 (SD=2.1) and 1.3 (SD=1.3), respectively (p<0.0001). The mean LUTSS value in the NP+ and NP- groups were 22.0 (SD=11.5) and 19.9 (SD=11.2), respectively (p=0.007). From all the potential risk factors queried, only age, number of voids per 24 hours, and nocturia episodes were strongly correlated with nocturnal polyuria. Table 1 shows a partial list of potential risk factors. Benign prostatic hyperplasia (BPH), pedal edema, sleep apnea, urethral obstruction, and hypertension were underrepresented, and overactive bladder (OAB) was overrepresented in the sample population. CONCLUSIONS We were surprised to see a lack of correlation between nocturnal polyuria and its known causes, such as sleep apnea and pedal edema. The data suggests that risk factors for nocturnal polyuria may be underreported in standard history taking. The 24 HBD remains the gold standard for diagnosing nocturnal polyuria. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1086-e1087 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Harjot Singh More articles by this author Jeffrey Weiss More articles by this author Jerry Blaivas More articles by this author Linda Dayan More articles by this author Noam Fine More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD32-08 VITAMIN D SUPPLEMENTATION FOR URGENCY URINARY INCONTINENCE IN POST-MENOPAUSAL WOMEN: A PILOT RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II1 Apr 2018PD32-08 VITAMIN D SUPPLEMENTATION FOR URGENCY URINARY INCONTINENCE IN POST-MENOPAUSAL WOMEN: A PILOT RANDOMIZED CLINICAL TRIAL Alayne Markland, T. Mark Beasley, Kathryn Burgio, Camille Vaughan, Vin Tangpricha, and Patricia Goode Alayne MarklandAlayne Markland More articles by this author , T. Mark BeasleyT. Mark Beasley More articles by this author , Kathryn BurgioKathryn Burgio More articles by this author , Camille VaughanCamille Vaughan More articles by this author , Vin TangprichaVin Tangpricha More articles by this author , and Patricia GoodePatricia Goode More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urgency urinary incontinence (UUI) is a very common, distressing condition. First-line behavioral and drug therapies are effective but novel therapies are needed. The primary aim of this study was to evaluate the efficacy of vitamin D supplementation compared to placebo to improve UUI in postmenopausal women with vitamin D insufficiency. METHODS This was a single-site pilot randomized trial conducted 2013-2017. Participants were community-dwelling postmenopausal women, 50 years of age or older, with at least 3 UUI episodes on 7-day bladder diary and 25(OH)D≤30 ng/mL (insufficiency). They were randomized to 12 weeks of weekly 50,000 IU vitamin D3 or placebo. Using Wilcoxon tests, we calculated the percent reduction in 24-hour UUI episodes (primary outcome), along with urinary frequency and nocturia episodes from the diaries for the overall group and for African American (AA) and obese women (higher-risk subgroups). Secondary outcomes included scores on validated bladder symptom questionnaires. RESULTS We randomized 56 women (50 to 84 years of age; mean age = 60.5 ±8.2; 70% AA; 64% obese), 28 to vitamin D and 28 to placebo; 51 completed treatment. For the completer analysis, mean 25(OH)D at baseline (21.2 ±5.2 and 18.2 ±5.6, p=0.30) improved to 57.9 ±16.3 for the vitamin D3 group and to 21.9 ±8.2 in the placebo group, p<0.001. UUI episodes per 24-hour day decreased 52.4% with vitamin D3 compared to 30.9% with placebo (p=0.09). Among Black women, changes in UUI episodes decreased 63.2% with vitamin D3 compared to 23.0% with placebo (p=0.03). There were no group differences among obese women (p=0.29). For all women, no differences between D3 and placebo were found for improvements in voiding frequency (p=0.40), nocturia (p= 0.40), incontinence symptom severity (p=0.80), or overactive bladder symptom severity (p=0.47). CONCLUSIONS Post-menopausal women with UUI and vitamin D insufficiency recorded a >50% decrease in UUI episodes that did not reach statistical significance compared to placebo, except in the subset of AA women. Based on these pilot study estimates for efficacy, further investigation of vitamin D3 alone or in combination with other treatments for UUI is warranted, particularly for women in higher-risk subgroups. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e648 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alayne Markland More articles by this author T. Mark Beasley More articles by this author Kathryn Burgio More articles by this author Camille Vaughan More articles by this author Vin Tangpricha More articles by this author Patricia Goode More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Onabotulinumtoxin-A improves health status and urinary symptoms in subjects with refractory overactive bladder: Real-life experience.

Onabotulinumtoxin-A has been approved for wet overactive bladder refractory to anticholinergics in randomised controlled trials; however, data from real-life practice are scarce. This study was designed to assess the efficacy of intravesical onabotulinumtoxin-A injections, focusing on health status, urinary symptoms and subjective satisfaction. Data from consecutive patients with overactive bladder-refractory to anticholinergics treated with onabotulinumtoxin-A were prospectively collected and analysed. Standard doses (100-150 U) were used, followed by repeat sessions when clinical benefits diminished. Efficacy and safety of repeat onabotulinumtoxin-A administrations were assessed at 12-week post-injection. Clinical parameters evaluated were: change in the magnitude and frequency of incontinence, urgency and nocturia episodes, change in the number of pads used and procedural complications. Quality of life was evaluated using the 36-Item Short-Form Health Survey, Overactive Bladder Screener and Treatment Benefit Scale questionnaires. Consecutive overactive bladder-refractory to anticholinergics patients ( n = 22) (median duration of oral therapy: 10 months) were enrolled. No intraoperative complications occurred, but two urinary retention cases were recorded. Forty-five percent of patients (10/22) were re-treated (median duration of perceived benefits: 18 months, range: 8-55 months). The number of urinary incontinence, frequency and nocturia episodes, and pads used went from 3.6, 11.3, 2.7 and 2.4 preoperatively to 1.0, 5.8, 0.7 and 0.7 postoperatively ( p < 0.005). Quality of life (36-Item Short-Form Health Survey) was significantly improved and symptom scores (Overactive Bladder Screener) were reduced, from 34.5 to 17.1 at week 12 ( p < 0.05). Eighty-seven percent of patients indicated improvement/great improvement in their condition (Treatment Benefit Scale). Intradetrusor injections of onabotulinumtoxin-A in patients with overactive bladder-refractory to anticholinergics significantly improved health status and urinary symptoms, with high subjective satisfaction.

Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence.

The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence. A planned secondary analysis of baseline characteristics of participants in a multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in ambulatory women self-diagnosed by the 3 Incontinence Questions was performed. Urinary symptoms were assessed by 3-day voiding diaries. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale. Of the 640 participants, mean (SD) age was 56 (±14) years and 68% were white. Participants reported an average of 3.9 (±3.0) urgency incontinence episodes per day and 1.3 (±1.3) episodes of nocturia per night. At baseline, 57% had poor sleep quality (PSQI score, >5) and 17% reported daytime sleepiness (Epworth Sleepiness Scale score, >10). Most women (69%) did not use sleeping medication during the prior month, whereas 13% reported use of sleeping medication 3 or more times per week. An increase in total daily incontinence episodes, total daily urgency incontinence episodes, total daily micturitions, and moderate to severe urge sensations were all associated with higher self-report of poor sleep quality according to the PSQI (all P ≤ 0.01). Higher scores on the Bother Scale and the Health-Related Quality of Life for overactive bladder on the Overactive Bladder Questionnaire were similarly associated with higher rates of poor sleep quality (both P ≤ 0.01). In subgroup analysis of those who took sleeping medications less than twice a week, there was still a significant relationship between incontinence measures and quality of sleep as measured by the PSQI. In multivariable analyses, greater frequency of nighttime urgency incontinence was associated with poor sleep quality (P = 0.03). Among ambulatory women with urgency urinary incontinence, poor sleep quality is common and greater frequency of incontinence is associated with a greater degree of sleep dysfunction. Women seeking urgency urinary incontinence treatment should be queried about their sleeping habits so that they can be offered appropriate interventions.

Short-term results of the efficacy of percutaneous tibial nerve stimulation on urinary symptoms and its financial cost.

Objective:Overactive bladder (OAB) affects 16.9% of women in the United States. Percutaneous tibial nerve stimulation (PTNS) is a third-line treatment for patients who are refractory to behavioral and pharmacologic therapies. We aimed to evaluate the effects of PTNS on urinary symptoms in patients diagnosed as having refractory OAB and investigate the cost of medications and clinical visits before and after PTNS treatment.Material and Methods:We reviewed 60 women with refractory OAB treated with PTNS. Episodes of urinary frequency, leakage, urgency, and nocturia; number of follow-up visits; and medications were recorded. The mean quarterly drug, physician, nurse, and provider costs were calculated. The episodes of urinary symptoms, numbers of follow-up visits, and costs of medications and visits before and after PTNS were compared.Results:Of the 60 patients with refractory OAB, 24 patients who completed 12 weekly sessions of initial PTNS were evaluated. The number of urinary symptoms and follow-up visits significantly decreased after PTNS (p<0.05). The average quarterly medication cost decreased from $656.36±292.45 to $375.51±331.79 after PTNS (p=0.001). After PTNS, quarterly physician and nurse visit costs decreased from $81.73±70.39 to $25.89±54.40 and from $55.23±38.32 to $15.53±19.58, respectively (p<0.05). The quarterly total provider cost was similar before and after PTNS.Conclusion:PTNS treatment significantly improved urinary symptoms of patients with refractory OAB and reduced the costs of medications and physician and nurse visits.

Acupuncture for adults with overactive bladder: A systematic review and meta-analysis of randomized controlled trials.

Background:Overactive bladder is stated as the occurrence of urinary urgency which will cause negative impacts and decrease patients’ health-related quality of life. The aim of this systematic review is to assess the efficiency and safety of acupuncture for adults with overactive bladder (OAB) comparing with sham-acupuncture, drugs, and acupuncture plus drugs.Methods:We independently searched 9 databases from beginning to August 15, 2017. Two writers extracted data at the same time independently. Study outcomes were calculated by standardized mean differences (SMD) with 95% confidence intervals (CIs) and mean difference (MD) with 95% CIs.Results:Ten randomized controlled trials (RCTs) with 794 patients were included in this systematic review. The combined results showed that electroacupuncture (EA) may be more effective than sham electroacupuncture (sham EA) in improving the 24-hour nocturia episodes and EA may enhance tolterodine for relieving voiding symptoms and enhancing patients’ quality of life. However, more trials with high quality and larger sample sizes will be needed in the future to provide sufficient evidence. Only 15 of 794 OAB patients from the included studies reported mild adverse reactions related to EA, therefore, acupuncture is safe for treating OAB.Conclusion:Acupuncture might have effect in decreasing the number of micturition episodes, incontinence episodes, and nocturia episodes. However, the evidence is insufficient to show the effect using acupuncture alone or the additional effect to drugs in treating OAB.

Urox containing concentrated extracts of Crataeva nurvala stem bark, Equisetum arvense stem and Lindera aggregata root, in the treatment of symptoms of overactive bladder and urinary incontinence: a phase 2, randomised, double-blind placebo controlled trial

BackgroundStorage lower urinary tract symptoms (LUTS) including overactive bladder (OAB) and urinary incontinence (UI) affect millions of people worldwide, significantly impacting quality of life. Plant based medicines have been documented both empirically and in emerging scientific research to have varying benefits in reducing bladder symptoms. We assessed the efficacy of Urox®, a proprietary combination of phytomedicine extracts including, Cratevox™ (Crataeva nurvala) stem bark, Equisetem arvense stem and Lindera aggregata root, in reducing symptoms of OAB and UI.MethodsEfficacy of the herbal combination on a variety of bladder symptoms compared to an identical placebo, were documented in a randomised, double-blind, placebo controlled trial conducted at two primary care centres. Data were collected at baseline, 2, 4 and 8 weeks, with the primary outcome being self-reported urinary frequency. Statistical analysis included mixed effects ordered logistic regression with post hoc Holm’s test to account for repeated measures, and included an intention-to-treat analysis.ResultsOne hundred and fifty participants (59% female, aged; mean ± SD; 63.5 ± 13.1 years) took part in the study. At week 8, urinary day frequency was significantly lower (OR 0.01; 95%CI 0.01 to 0.02; p < 0.001) in response to treatment (mean ± SD; 7.69 ± 2.15/day) compared to placebo (10.95 ± 2.47/day). Similarly, episodes of nocturia were significantly fewer (OR 0.03; 95%CI 0.02 to 0.05) after 8 weeks of treatment (2.16 ± 1.49/night) versus placebo (3.14 ± 1.36/night). Symptoms of urgency (OR 0.02; 95%CI 0.01 to 0.03), and total incontinence (OR 0.03; 95% CI 0.01 to 0.06) were also lower (all p < 0.01) in the treatment group. Significant improvements in quality of life were reported after treatment in comparison to placebo. No significant side effects were observed resulting in withdrawal from treatment.ConclusionsThe outcome of this study demonstrated both statistical significance and clinical relevance in reducing symptoms of OAB, urinary frequency and/or urgency and incontinence. The demonstrated viability of the herbal combination to serve as an effective treatment, with minimal side-effects, warrants further longer term research and consideration by clinicians.Trial registrationNCT02396160 (registered on 17 March 2015 - before any statistical analyses commenced).

Is It Worth Treating Non-Bothering Nocturia? Results of a Multicenter Prospective Observational Study.

PurposeThe purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia.Materials and MethodsIn this prospective multicenter study, patients who visited hospitals for treatment of voiding symptoms were enrolled. Inclusion criteria were: 1) men >45 years, and 2) nocturia ≥2 confirmed by a three-day voiding diary. Subjects were divided into non-bothering and bothering groups based on International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) question 2b. Changes in voiding symptoms, frequency of nocturia, and bothersomeness were evaluated with international prostate symptom score (IPSS), ICIQ-N, and three-day voiding diary at 4 and 12 weeks after treatment.ResultsA total of 48 patients in the non-bothering nocturia group and 50 patients in the bothering nocturia group who completed the 12-week treatment were analyzed. The total IPSS was decreased by 5.8 in the non-bothering group and 5.2 in the bothering group. There was no significant difference in decrease of IPSS between the two groups. Both groups showed significant reduction in discomfort of nocturia. The ICIQ-N 2b score decreased from 3.9 to 2.7 (p=0.01) in the non-bothering group and from 6.9 to 4.6 (p=0.02) in the bothering group. The number of nocturia episodes was significantly decreased in both groups.ConclusionsRegardless of discomfort associated with nocturia, both groups showed significant improvement in nocturia-related discomfort and voiding symptoms. These results suggest that patients with nocturia who were unaware of its discomfort benefited from treatment.

Systematic review and meta-analysis on the efficacy and tolerability of mirabegron for the treatment of storage lower urinary tract symptoms/overactive bladder: Comparison with placebo and tolterodine.

A systematic review and meta-analysis was carried out to evaluate the efficacy and safety of mirabegron 50 mg and 100 mg in the treatment of storage lower urinary tract symptoms/overactive bladder in comparison with a placebo and tolterodine 4 mg. A total of 491 articles were collected and eight randomized studies were identified as eligible for this meta-analysis. Overall, eight trials were included in the meta-analysis evaluating 10 248 patients. Mirabegron at both doses of 50 mg and 100 mg, and and tolterodine 4 mg were significantly associated with the reduction of incontinence episodes per 24 h, reduction of mean number of micturitions per 24 h, increase of voided volume and reduction of urgency episodes per 24 h, compared to a placebo. Both mirabegron 50 mg and mirabegron 100 mg were associated with a significant reduction of nocturia episodes when compared with a placebo. Conversely, tolterodine 4 mg did not prove to be more effective than a placebo in the reduction of nocturia episodes. Furthermore, mirabegron 50 mg showed a slightly, but significantly, better efficacy than tolterodine 4 mg in the improvement of nocturia episodes. Mirabegron 50 mg and mirabegron 100 mg shared the same risk of overall treatment-emergent adverse events rate with the placebo. Otherwise, tolterodine 4 mg was associated with a significantly greater risk than the placebo. However, mirabegron 100 mg showed a slight trend toward an increased risk of hypertension (odds ratio 1.41; P = 0.08) and cardiac arrhythmia (odds ratio 2.18; P = 0.06). Mirabegron is an effective treatment for patients with storage lower urinary tract symptoms/overactive bladder, providing a reduction of incontinence, urgency and frequency; an improvement of voided volume with a slight, but statistically, significant improvement of nocturia; with a good safety profile. These findings should be considered for the treatment planning of patients with storage lower urinary tract symptoms/overactive bladder.

Sleep disturbance in men receiving androgen deprivation therapy for prostate cancer: The role of hot flashes and nocturia.

Patients with prostate cancer receiving androgen deprivation therapy (ADT) are at risk of sleep disturbance; however, to the authors' knowledge, the mechanisms by which ADT may affect sleep are not well understood. The current study compared objective and subjective sleep disturbance in ADT recipients and controls and examined whether sleep disturbance in ADT recipients is attributable to the influence of ADT on hot flashes and nocturia. Patients with prostate cancer were assessed before or within 1 month after the initiation of ADT as well as 6 months and 12 months later (78 patients). Patients with prostate cancer were treated with prostatectomy only (99 patients) and men with no history of cancer (108 men) were assessed at similar intervals. Participants self-reported their sleep disturbance (Insomnia Severity Index) and interference from hot flashes (Hot Flash Related Daily Interference Scale). One hundred participants also wore actigraphs for 3 days at the 6-month assessment to measure objective sleep disturbance and reported their nocturia frequency. ADT recipients reported worse sleep disturbance, higher rates of clinically significant sleep disturbance, and greater hot flash interference than controls (Ps≤.03). In cross-sectional analyses among those with actigraphy data, ADT recipients had greater objective sleep disturbance and more episodes of nocturia (Ps<.01). Cross-sectional mediation analyses demonstrated that the association between ADT and objectively and subjectively measured sleep disturbance was partly attributable to nocturia and hot flashes (Ps<.05). The results of the current study suggest that the association between ADT and sleep may be partly explained by nocturia and hot flash interference. Future studies should examine behavioral and pharmacologic interventions to address these symptoms among ADT recipients. Cancer 2018;124:499-506. © 2017 American Cancer Society.

A medical device containing purified bovine colostrum (Monurelle Biogel) in the treatment of vulvovaginal atrophy in postmenopausal women: Retrospective analysis of urinary symptoms, sexual function, and quality of life.

This study assessed the effectiveness and safety of a medical device containing purified bovine colostrum (Monurelle Biogel; Zambon, Bresso, Italy) in improving vulvovaginal atrophy (VVA), sexual function, urinary symptoms, and quality of life (QoL) in postmenopausal women. In all, 172 postmenopausal women with VVA were included in the study. All women were treated with vaginal Monurelle Biogel daily for 12 weeks. Patients underwent clinical examinations, completed a 3-day voiding diary, and had VVA graded using the Vaginal Health Index (VHI) at baseline and 12 weeks. Patients also completed the Female Sexual Function Index (FSFI), overactive bladder questionnaire (OAB-Q), and the Urogenital Distress Inventory (UDI-6), among others. After 12 weeks, there were significant increases in mean (± SD) VHI (12.53 ± 3.67 vs. 19.31 ± 3.49; P < .0001), the number of patients engaging in regular sexual activity 102 (59.3%) vs. 144 (83.7%), and in the total FSFI score (21.64 ± 2.99 vs. 28.16 ± 1.93; P < .0001) compared with baseline. In addition, there were significant reductions in the mean number of 24-hour voids (9.57 ± 2.12 vs. 7.13 ± 1.22; P < .0001), urgent micturition episodes per 24 hours (1.75 ± 0.76 vs. 1.14 ± 0.87; P = .001), nocturia episodes (1.58 ± 0.85 vs. 0.97 ± 1.18; P = .0002), and urinary incontinence episodes per 24 hours (0.74 ± 0.59 vs. 0.28 ± 0.52; P = .003). Finally, after 12 weeks treatment, there were significant differences in UDI-6 (7.85 ± 0.81 vs. 5.56 ± 1.40), OAB-Q symptom (53.60 ± 12.57 vs. 22.08 ± 9.63), and OAB-Q health-related QoL (21.75 ± 8.51 vs. 69.34 ± 14.59) scores compared with baseline (P < .0001 for all). The Patient Impression of Global Improvement scale revealed global improvement in 143 women (83.14%). Monurelle Biogel is an effective treatment for VVA in postmenopausal women, improving sexual life, urinary symptoms, and QoL.

The Degree Of Bother Of Nocturea On Quality Of Life In A Group From Al-Diwaniya Population

Background: Nocturia is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless.Objective: To evaluate the bothersome effect of nocturia on health related quality of life (HRQoL) in a group from Al-Diwaniya population.Patients and methods: In 2006–2008, a survey was made on a random sample of 600 patients aged 18–79 yr who were identifiedfrom Al-Diwaniya teaching hospital, proportion was 62% males and 38% were females).Measurements: bother from nocturia on QoL were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Score). Bother from nocturia was assessed on a four-point scale (none, small, moderate, major). Results and limitations: Degree of bother increased with nocturia frequency (p &lt; 0.01). The most commonly cited degree of bother forthose with one, two, and three nightly voids was no bother, small bother, and moderate bother, respectively.Conclusions: At least two voids per night are bothersome and associated with impaired HRQoL. The majority of people report having bothered when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and, thus, is not a suitable criterion for clinically relevant nocturia.

A different way to study frequency volume charts in patients with nocturia.

Nocturia results from a mismatch between bladder capacity and nocturnal urine production (NUP), which is determined with a frequency volume charts (FVC). This is the first study that aimed to describe variations in nocturia severity and its associated factors by evaluating FVCs per single 24 h-period. This was a post-hoc analysis of patients who completed a 72 h-FVC in prospective, observational studies. The nocturnal polyuria index (NPi ) was defined as the ratio of nocturnal and 24 h urine output. Subgroups were defined according to variations in nocturia frequency during the three 24 h-periods of the FVC (fluctuating/consistent) and to the number of nocturia episodes during a single night (0/1/≥2). We analyzed 504 24 h-FVC, collected by 168 subjects (58% female) with a median age of 60 (50-68) years. Nocturia frequency fluctuated in 69 (41%) subjects. For the same number of nocturnal voids, we found no differences in NPi and maximum voided volume (MVV) between consistent and fluctuating nocturia frequency. Increasing numbers of nocturnal voids were associated with an increasing NPi in subjects with fluctuating nocturia, while for consistent nocturia, it was linked to an increase in NPi and a decrease in MVV. For both subjects with fluctuating and consistent nocturia, increasing nocturia severity was associated with increasing daytime fluid intake. For the same number of nocturnal voids, bladder capacity, and NUP were similar between patients with consistent and fluctuating nocturia. An increasing number of nocturnal voids in subjects with fluctuating nocturia was linked to more NUP and more daytime fluid intake.

Comparison of the efficacy of Solifenacin Succinate and Tolterodine for the treatment of overactive bladder syndrome

Background : Overactive Bladder Syndrome(OAB) is not an uncommon problem. Although exact incidence of this disease in our country is not known but a significant number of people suffering from this disease seek treatment at the Urology department of different hospitals. At present two common antimuscarinic drug Solifenacin Succinate and Tolterodine are available in our country for the treatment of OAB.Objective : To compare the efficacy of Solifenacin Succinate and Tolterodine to treat OAB.Methodology : This hospital based randomized control trial was conducted in the Department of Urology, Dhaka Medical College Hospital, Dhaka and a private hospital from January 2009 to December 2010 to compare the efficacy of two new generation antimuscarinics, Solifenacin succinate and Tolterodine at their recommended doses for the treatment of OAB.Results : After 3 months of treatment it has clearly shown that Solifenacin is more effective in reducing OAB symptoms compared with extended release preparation of Tolterodine. This include statistically significant reduction in episodes of frequency, urgency, urge incontinence, nocturia and significant improvement of voided volume.Northern International Medical College Journal Vol.8(2) January 2017: 231-234

Retrospective analysis in 46 women with vulvovaginal atrophy treated with ospemifene for 12 weeks: improvement in overactive bladder symptoms

Aims: The aim of this study was to assess the effectiveness and safety of ospemifene in the improvement of overactive bladder (OAB) symptoms in postmenopausal women affected by vulvovaginal atrophy (VVA).Methods: Forty-six postmenopausal patients affected by VVA with OAB syndrome were enrolled for the study. All patients received Ospemifene 60 mg for 12 weeks. Clinical examination, 3-day voiding diary, urodynamic testing, ultrasound measurement of endometrial and bladder wall thickness (BWT) and the Vaginal Health Index (VHI) were performed at baseline and 12 weeks. Patients completed the OAB-Q SF and UDI-6.Results: After 12-weeks, the number of patients with detrusor overactivity decreased from 39% to 13% (p = 0.04). The reduction in the mean number in 24 h of voids (9.57 ± 2.12 vs. 6.63 ± 1.22, p < 0.0001), urgent micturition episodes/24 h (5.63 ± 1.46 vs. 1.44 ± 1.31, p < 0.0001), nocturia episodes (3.17 ± 0.85 vs. 1.11 ± 1.18, p < 0.0001), urinary incontinence episodes/24 h (0.85 ± 0.96 vs. 0.33 ± 0.64, p = 0.003) was observed. The UDI-6, OAB-Q symptoms, OAB-Q (HRQL) scores were 8.95 ± 0.91 vs. 5.56 ± 1.40, 62.60 ± 14.70 vs. 20.08 ± 10.83 and 18.71 ± 7.41 vs. 79.45 ± 14.47 (p < 0.001) before and after 12 weeks.Conclusion: Ospemifene is an effective potential therapy for postmenopausal women with VVA improving OAB symptoms and quality of life.

Fesoterodine for the Treatment of Nocturnal Urgency in Patients with Overactive Bladder Syndrome: An Analysis of Responders and Nonresponders

A recent study demonstrated improvement in nocturnal urgency in patients with overactive bladder when treated with fesoterodine. In the current study we aimed to determine which bladder diary parameters predict the response to fesoterodine in these patients. Patients with nocturnal urgency completed a 2-week, single-blind placebo run-in followed by 1:1 double-blind randomization to 12 weeks of fesoterodine or placebo. We analyzed bladder diary parameter changes from baseline to week 12, including the actual number of night voids (total number of nocturia episodes), maximum voided volume, nocturnal bladder capacity, Nocturnal Bladder Capacity Index (NBCi) (actual number of night voids - nocturnal urine volume/maximum voided volume - 1), nocturnal urine volume, the nocturia index (nocturnal urine volume/maximum voided volume) and the nocturnal polyuria index (nocturnal urine volume/24-hour volume). Additionally, we analyzed OAB-q (Overactive Bladder Questionnaire) changes. There was a linear relationship between the likelihood of being a responder for NBCi and the nocturia index. Responders had a significant decrease in nocturnal urine volume relative to baseline (-181.7 ml, p <0.01). Neither group showed a significant change in maximum voided volume relative to baseline. There was a significant decrease in NBCi and the nocturia index in responders (-0.82 and -0.61, respectively, each p <0.01). Responders demonstrated improvement in the OAB-q concern, coping, sleep, bother and total score metrics. Patients with nocturnal urgency secondary to overactive bladder syndrome and low nocturnal bladder capacity with a mismatch between nocturnal urine production and bladder capacity may benefit from fesoterodine. Symptom improvement appears to be mediated by increases in typical rather than maximum nocturnal voided volumes. Symptom improvement was associated with improved quality of life.

A multicenter real-life study of the efficacy of an alpha-blocker with or without anticholinergic agent (imidafenacin) treatment in patients with lower urinary tract symptoms/benign prostatic hyperplasia and storage symptoms.

To evaluate the efficacy and safety of combination therapy comprising a short-acting anticholinergic, imidafenacin and an alpha-blocker compared with monotherapy with an alpha-blocker only in men with lower urinary tract symptoms (LUTS) and storage symptoms. The 12-week, prospective, double-blind, randomised trial enrolled men with LUTS and storage symptom. The inclusion criteria were a total International Prostate Symptom Score (IPSS) ≥12, an IPSS question 4 score ≥2, ≥8 micturitions in 24hours, and a prostate volume >20mL. The primary outcome was a change in the micturition number from baseline. Bladder diary variables, Patient Perception of Intensity of Urgency Scale (PPIUS) scores, IPSS and safety were assessed. Of 260 patients screened, 221 completed the study. Patients were randomly assigned to receive an alpha-blocker only (n=111, group 1) or combination therapy comprising an alpha-blocker and an anticholinergic (n=110, group 2) for 12weeks. Group 1 and 2 showed significant improvement in their 24-hour micturition numbers (-1.87 and -2.08, respectively), nocturia episodes (-0.48 and -0.53, respectively), total IPSS (-9.9 and -8.8, respectively), and PPIUS scores (-0.19 and -0.24, respectively). Micturition number per 24hours, daytime frequency, urgency, the PPIUS score, the IPSS question 4 score and IPSS QoL score improved significantly in the combination therapy group, but changes in total IPSS, nocturia episodes, and safety outcomes did not differ significantly between the groups. Compared with treatment with an alpha-blocker alone, combination therapy comprising an anticholinergic and an alpha-blocker showed superior efficacy and its safety was similar in patients with LUTS and storage symptoms.