Nocturnal Bladder Capacity Research Articles

34 - Evaluation of nocturia in patients affected by severe obstructive sleep apnea syndrome by Nocturnal Bladder Capacity Index

34 - Evaluation of nocturia in patients affected by severe obstructive sleep apnea syndrome by Nocturnal Bladder Capacity Index

Nocturnal Bladder Function and Sleep in the Children with Refractory Nocturnal Enuresis: A Prospective Study

To prospectively investigate the nocturnal bladder function and sleep in children with refractory primary monosymptomatic nocturnal enuresis (RPMNE). Fifty-three children diagnosed with RPMNE and 30 controls who had upper urinary tract abnormality but without any voiding problems were included in the study. RPMNE patients underwent a standardized investigation protocol, including the Pittsburgh Sleep Quality Index (PSQI) questionnaire, a 7-day bladder diary, and the simultaneous ambulatory urodynamic monitoring and polysomnography (PSG); controls were evaluated using the PSQI questionnaire and PSG. The children with RPMNE were subdivided into the nocturnal detrusor overactivity (NDO) case group and the non-NDO case group. The children in the NDO case group had a higher percentage of total sleep time in light sleep and a lower percentage in the N3 sleep stage than those in the non-NDO case group and control group (P<.05). The cortical arousal index and PSQI scores of both RPMNE subgroups were higher compared to the control group (P<.05). The incidences of reduced nocturnal bladder capacity (NBC) in the NDO case group were higher than in the non-NDO case group (P<.05). The frequency of involuntary detrusor contractions during sleep was positively correlated with cortical arousal index in the NDO case group (r=0.811, P<.0001). In addition to the reduced NBC, the RPMNE is related to abnormal NDO, increased light sleep period, and cortical arousal dysfunction. Moreover, there is a certain correlation between the abnormal degrees of NDO and cortical arousal dysfunction.

Effectiveness and Safety of a Mixture of Nobiletin and Tangeretin in Nocturia Patients: A Randomized, Placebo-Controlled, Double-Blind, Crossover Study.

Nobiletin and tangeretin (NoT) are flavonoids derived from the peel of Citrus depressa, and they have been found to modulate circadian rhythms. Because nocturia can be considered a circadian rhythm disorder, we investigated the efficacy of NoT for treating nocturia. A randomized, placebo-controlled, double-blind, crossover study was conducted. The trial was registered with the Japan Registry of Clinical Trials (jRCTs051180071). Nocturia patients aged ≥50 years who presented nocturia more than 2 times on a frequency-volume chart were recruited. Participants received NoT or a placebo (50 mg once daily for 6 weeks), followed by a washout period of ≥2 weeks. The placebo and NoT conditions were then switched. Changes in nocturnal bladder capacity (NBC) were the primary endpoint, and changes in nighttime frequency and nocturnal polyuria index (NPi) were secondary endpoints. Forty patients (13 women) with an average age of 73.5 years were recruited for the study. Thirty-six completed the study, while four withdrew. No adverse events directly related to NoT were observed. NoT had little effect on NBC compared with the placebo. In contrast, NoT significantly changed nighttime frequency by -0.5 voids compared with the placebo (p = 0.040). The change in NPi from baseline to the end of NoT was significant (-2.8%, p = 0.048). In conclusion, NoT showed little change in NBC but resulted in decreased nighttime frequency with a tendency toward reduced NPi.

MP71-19 ADDITION OF ACE INHIBITORS/ARBS TO HYDROCHLOROTHIAZIDE THERAPY ALLEVIATES NOCTURIA IN PATIENTS WITH HYPERTENSION

You have accessJournal of UrologyCME1 Apr 2023MP71-19 ADDITION OF ACE INHIBITORS/ARBS TO HYDROCHLOROTHIAZIDE THERAPY ALLEVIATES NOCTURIA IN PATIENTS WITH HYPERTENSION Claire Sunha Choi, Alexander Fang, Connelly Miller, Thomas Monaghan, Jude Appiah, Lauren Fink, and Jeffrey Weiss Claire Sunha ChoiClaire Sunha Choi More articles by this author , Alexander FangAlexander Fang More articles by this author , Connelly MillerConnelly Miller More articles by this author , Thomas MonaghanThomas Monaghan More articles by this author , Jude AppiahJude Appiah More articles by this author , Lauren FinkLauren Fink More articles by this author , and Jeffrey WeissJeffrey Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The association between nocturia and hypertension (HTN) is well-documented. Although recent studies suggest an increased risk of nocturia in patients with treated but uncontrolled hypertension, there is a lack of drug-specific data. With this in mind, we studied the effect of two common antihypertensive agents – hydrochlorothiazide (HCTZ) and angiotensin-converting enzyme inhibitors (Ace-I)/angiotensin II receptor blocker (ARB) – on nocturia in patients with hypertension. METHODS: We performed a retrospective analysis of voiding diaries from adult males who were diagnosed with HTN and treated for lower urinary tract symptoms at Brooklyn Veterans Affairs urology clinic. After excluding patients with comorbidities (obstructive sleep apnea, congestive heart failure, chronic kidney disease, diabetes insipidus and mellitus), subjects were divided into four groups: (1) untreated, (2) HCTZ only, (3) Ace-I/ARB only, and (4) HCTZ and Ace-I/ARB. One-way ANOVA with Tukey’s post-hoc test was performed to compare bladder diary parameters and nocturnal urge perception grade (UPG). RESULTS: A total of 234 diaries of adult males with hypertension (mean age±standard deviation=69.3±10.4, systolic BP=129.3±16.6, diastolic BP=76.1±11.0) were analyzed. Amongst 4 subgroups, hypertensive patients on HCTZ only had the most severe nocturia symptoms with highest actual number of voids (ANV) and nocturia index (Ni) with increased mean nocturnal UPG. This was associated with reduced maximum voided volume (MVV) and increased nocturnal bladder capacity index (NBCi), suggesting diminished bladder capacity in patients on HCTZ only. Interestingly, when Ace-I/ARBs were added to HCTZ, there was a reduction in ANV (p=0.014), NBCi (p=0.001) and UPG (p<0.001). CONCLUSIONS: The findings of this study imply that HCTZ worsens nocturia in hypertensive patients likely via diminished nocturnal functional bladder capacity, and addition of ACE Inhibitors/ARBs is associated with reduced nocturia severity. Given that thiazide diuretics and Ace-I/ARBs are frequently prescribed in combination, these results suggest a potential for personalized therapies on treatment of nocturia in patients with hypertension. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1022 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Sunha Choi More articles by this author Alexander Fang More articles by this author Connelly Miller More articles by this author Thomas Monaghan More articles by this author Jude Appiah More articles by this author Lauren Fink More articles by this author Jeffrey Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

Nocturia: its characteristics, diagnostic algorithm and treatment.

Nocturia is the complaint that an individual has to wake up at night one or more times to urinate. It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function and vitality. It is clinically important to distinguish it from global polyuria, defined as a urinary rate ≥ 125ml/h (3000ml/day), as well as from nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production. A Frequency Volume Chart (FVC), overnight water deprivation test with renal concentrating capacity test, and the nocturnal bladder capacity index are some of the methods that help establish the underlying pathology of this condition and hence define an adequate treatment plan.

A0649 - Mirabegron and Solifenacin in treatment of primary nocturnal enuresis with reduced nocturnal bladder capacity: A randomized double blind placebo controlled study

A0649 - Mirabegron and Solifenacin in treatment of primary nocturnal enuresis with reduced nocturnal bladder capacity: A randomized double blind placebo controlled study

The Relationship Between Overactive Bladder and Nocturia

Overactive bladder (OAB) syndrome is a major risk factor for the occurrence of nocturia. In OAB patients, nocturia is driven by low nocturnal bladder capacity. OAB medications would probably demonstrate better performance in populations with greater nocturia severity at baseline.

Definition of low nocturnal bladder capacity in Japanese enuretic children

Definition of low nocturnal bladder capacity in Japanese enuretic children

The clinical features and predictive factors of nocturnal enuresis in adult men

ObjectivesTo characterise the clinical features and to discover predictive factors of adult males with nocturnal enuresis (NE).Patients and MethodsA total of 43 eligible adult male patients (mean age was 57.8 years) were recruited prospectively over a 2‐year period. After documentation of medical history, lower urinary tract symptoms (LUTS) were assessed using the International Consultation on Incontinence Modular Questionnaire‐male LUTS (ICIQ‐MLUTS), and a 3‐day ICIQ‐bladder diary (ICIQ‐BD). Video‐urodynamic studies (VUDS) were conducted conforming to the International Continence Society standards. Univariate and multivariate linear regressions were performed to determine potential predictive factors.ResultsPatients with NE had a variety of LUTS and had a high incidence of obesity and comorbidities. On the ICIQ‐BD, NE was associated with nocturnal polyuria (NP), reduced nocturnal bladder capacity (NBC), or a combination of both. Subgroup analysis indicated that patients with more frequent NE had: higher body mass index (BMI); more comorbidities; reduced daytime urinary frequency and urgency quality of life (QoL) sub‐scores; and increased stress urinary incontinence (SUI) and nocturnal bedwetting sub‐scores. Patients with reduced NBC only, had fewer NE episodes, while patients with NP, or with both NP and reduced NBC were more likely have frequent NE. Multivariate analysis confirmed that: BMI; neurogenic causes; sub‐scores of SUI QoL and bedwetting domain; the presence of reduced NBC, and both NP and reduced NBC; and bladder outlet obstruction, were all independent predictive factors for the severity of NE.ConclusionsNE n the adult male should be systemically assessed and treated, as obesity, neurogenic disorders, excessive urine production, bladder storage and emptying dysfunctions are risk factors. Bladder diaries and VUDS provide valuable information on potential pathophysiological causes, which could assist clinical evaluation and selection of focussed treatment.

1012 Urologic Features Related to the First Uninterrupted Sleep Period (FUSP) in Nocturia

Abstract Introduction In nocturia, longer FUSP (time to first void) correlates with better quality sleep (Bliwise et al, JCSM 2015;11:53-5) and, with treatment, longer FUSP is associated with decreased nightly voids (Epstein et al, Neurourol Urodyn 2018;37:186-91). We examined urologic correlates of FUSP in an outpatient nocturia population without comorbidities (CHF, OSA, ESRD, diuretics). Methods Participants (n=119; men) kept a home flow/volume diary, tracking clock time and quantity of each urination across a 24-hr period. FUSP was defined as time between going to bed and time of first void. We analyzed the urine volume at first nocturnal void (FNVV) (i.e., at end of FUSP). We also analyzed all nighttime volumes and divided by reported hours of sleep to impute nocturnal urine production (NUP) (in ml/hr, classified as high [&amp;gt;90 ml/hr] [n=49] vs low [&amp;lt;90 ml/hr] [n=60])—a measure correlated with number of nocturia episodes (van Doorn et al, J Urol 2014;191:1034-9). Nocturnal maximal voided volume (NMVV) at any single nocturnal void defined maximal functional nocturnal bladder capacity. Data were analyzed non-parametrically. Results For 53 of 119 patients, FNVV was identical to NMVV. This was more likely in patients with NUP &amp;gt;90 ml/hr vs &amp;lt;90 ml/hr (59% vs 40%, p=.046). High (vs low) NUP rates were also associated with higher FNVV (300 [225-420] vs 135 [100-200] ml, p&amp;lt;.001), as well as higher number of voids (3 vs. 2, p=.03). Conclusion For nearly half of these nocturia patients, the volume at first void occurred at their maximal nocturnal volume. In nocturia, higher FNVV also reflects greater overall nocturnal volume of urine produced, and excess urine volume (as opposed to insufficient bladder capacity) likely plays a central role in the pathogenesis of nocturia in these patients. The extent to which these higher initial volumes represent free-water vs solute-driven clearance is currently under investigation. Support N/A

PD37-01 TREATMENT OF NOCTURIA

INTRODUCTION AND OBJECTIVE: This study aims to assess the efficacy of behavioral modification alone vs. combined behavioral modification with traditional first-line pharmacologic treatments in reducing nocturnal voiding frequency among men with nocturia. METHODS: Retrospective analysis of voiding diaries completed by patients treated for lower urinary tract symptoms (LUTS) at a Veterans Affairs urology clinic was performed. Diaries were abstracted for 24-h total volume, nocturnal urine volume (NUV), and actual number of nocturnal voids (ANV). Patients were included if they were male, ≥18 years, had ≥1 nocturnal void(s) on baseline diary, and a follow-up diary within 365 days of baseline. Patients were deemed to have experienced improvement if ANV decreased by ≥1 voids(s) from baseline to follow-up. RESULTS: 321 voiding diaries (176 diary pairs) were analyzed from 98 unique patients who met the inclusion criteria. Mean duration from baseline to follow-up was 181 days. Improvement was observed in 67 diary pairs (mean improvement -1.76 [±1.07] voids); no change was observed in 44 diary pairs, and 65 demonstrated an increase in ANV (+1.86 [±1.91] voids). Among those who improved, baseline ANV was significantly greater (3.5 vs. 2.1 voids, p<0.001), and baseline post-void residual (PVR) volume was lower (45.7 vs. 89.3, p=0.03). No other differences were observed in standard diary parameters. Improvement in ANV was accompanied by a significant decrease in 24-h volume (-344 mL, p=0.01), NUV (-262 mL, p<0.001), and an increase in first uninterrupted sleep period (FUSP) duration (+1.92 hours, p<0.001). Patients prescribed behavioral modification + 1 or more pharmacologic agent were no more likely to improve than patients prescribed lifestyle modification alone. Irrespective of pharmacotherapy status, improvement was accompanied by significant decreases in ANV, total 24-h voids voids, nocturnal bladder capacity index (NBCi), and nocturia index (Ni), as well as increased FUSP (Table). CONCLUSIONS: In this study, no significant difference was observed in nocturia severity between patients treated with behavioral modification alone vs. combined behavioral modification + pharmacologic agent(s). Alternative pharmacologic options may be needed to expand the urologist’s toolkit beyond an initial individualized lifestyle modification plan in the management of nocturia.Source of Funding: None

Prevalence, subtypes, and correlates of nocturia in the symptoms of Lower Urinary Tract Dysfunction Research Network cohort.

We determined the prevalence, severity, and correlates of nocturia in a large clinical cohort of patients. Patients presenting with lower urinary tract symptoms (LUTS) completed 3-day bladder diaries. Nocturia was quantified based on the mean number of nighttime voids documented over the 3 days. Nocturia subtypes (global polyuria, nocturnal polyuria [NP], reduced global bladder capacity, and reduced nocturnal bladder capacity) were assessed. Bother due to nocturia was measured by the LUTS Tool. Sleep quality was assessed with the Patient-Reported Outcomes Measurement Information System Sleep Scale. Multivariable multinomial regression was used to explore patient characteristics associated with nocturia. In 502 participants with analyzable diaries (285 men and 217 women), the mean number of nocturia episodes over 3 days was 0 in 103 (20.5%), >0 to <1 in 151 (20.1%), 1 to <2 in 165 (32.9%), and ≥2 in 83 (16.5%). Sixty-seven percent of the participants with nocturia ≥1 reported significant bother from their nocturia. NP was the most common nocturia subtype and was present in 17% of those with nocturia = 0, 40% of those with nocturia >0 to <1, 65% of those with nocturia 1 to <2%, and 77% with nocturia 2+. Higher degrees of nocturia were associated with male sex, greater sleep disturbance, and a higher likelihood of exhibiting multiple nocturia subtypes. Nocturia ≥1 occurred in 49% of LUTS patients and caused significant bother in the majority of them. The most common subtype was NP, but a substantial proportion of patients exhibited additional characteristics.

Classification of nocturia by analyzing frequency volume chart and relations with international prostate symptom score in male patients with lower urinary tract symptoms in Korea

PurposeTo evaluate the categories of nocturia and relationships with the international prostate symptom score (IPSS) in Korean men with lower urinary tract symptoms (LUTS) accompanying nocturia.Materials and MethodsFive hundred twenty-one male patients from five different hospitals, aged ≥18 years, were included. The 3-day frequency volume chart was used to identify nocturia. We also used the IPSS and The International Consultation on Incontinence Modular Questionnaire-Nocturia (ICIQ-N) module to verify the correlation between nocturia and quality of life.ResultsThe distribution of nocturia events varied from 1 to 11, and 2 nocturia events were most prevalent (48.4%). Across the various numbers of nocturia events, the mean age, first sleep period, functional bladder capacity (FBC), nocturnal polyuria index (NPI), nocturia index (NI), predicted number of nightly voids, and nocturnal bladder capacity index (NBCI) were statistically different. Patients with pure nocturnal polyuria showed different night lengths, nocturnal urine volume, FBC, NPI, NI, and predicted number of nightly voids than those without nocturnal polyuria. Patients with severely reduced NBCI were prominent in the IPSS >20 group, and the degree of vexation increased with the number of nocturia events. The IPSS storage symptom score and ICIQ-N symptom score positively correlated with nocturia events.ConclusionsIn Korean male LUTS patients with nocturia, mixed-type nocturia was prominent, and patients with a high IPSS had a much poorer sleep quality than those with a low IPSS.

Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial.

PurposeTo compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE).MethodsNinety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment.ResultsAfter training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups.ConclusionsBoth intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.

Etiology of nocturia response in men with diminished bladder capacity.

To test the hypothesis that patients with nocturia owing to diminished global or nocturnal bladder capacity improve via increased bladder capacity. This is a retrospective analysis of voiding diaries completed at a VA urology clinic between 2008-2017. Inclusion required patients aged at least 18 years, male, undergoing treatment for nocturia, and having completed at least two 24-hour voiding diaries ≥1 month apart. Patients were divided into two cohorts: responders (any decline in nocturia) and non-responders (no change or any increase in nocturia). Patients were further sub-stratified as having low global bladder capacity (maximum voided volume [MVV] <200 mL) versus low nocturnal bladder capacity (nocturnal maximum voided volume [NMVV] <200 mL and MVV ≥200 mL). Wilcoxon rank-sum was applied with a Bonferroni correction to test significance. Forty pre- and post-treatment diaries from 27 patients, and 19 pre- and post-treatment diaries from 17 patients were identified as having low global and low nocturnal bladder capacity, respectively. Nocturia responders with low global bladder capacity demonstrated significant decline compared to non-responders in nocturnal urine volume (NUV) (-140 vs +75, P < 0.01) and nocturnal bladder capacity index (NBCi) (-0.59 vs +0.23, P < 0.01). Patients with low nocturnal bladder capacity similarly demonstrated decreased NUV (-30 vs +160, P = 0.04) and NBCi (-1.4 vs +0.33, P < 0.01). There was no significant change in MVV or NMVV for either group. Treatment directed at lowering nocturnal urine production and enabling patients to consistently void at capacity is a rational strategy to treat nocturia in patients with low bladder capacity.

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

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

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.

MP36-13 CHANGES IN NOCTURNAL BLADDER DIARY PARAMETERS IN MEN AFTER URETHROPLASTY FOR ANTERIOR URETHRAL STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2017MP36-13 CHANGES IN NOCTURNAL BLADDER DIARY PARAMETERS IN MEN AFTER URETHROPLASTY FOR ANTERIOR URETHRAL STRICTURES Rajveer Purohit, Jyoti D. Chouhan, frank copeli, Dennis Robins, Andrew Tam, and Jeffrey P Weiss Rajveer PurohitRajveer Purohit More articles by this author , Jyoti D. ChouhanJyoti D. Chouhan More articles by this author , frank copelifrank copeli More articles by this author , Dennis RobinsDennis Robins More articles by this author , Andrew TamAndrew Tam More articles by this author , and Jeffrey P WeissJeffrey P Weiss More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1124AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated changes in nocturnal voiding patterns of men before and after anterior urethroplasty for urethral stricture disease using a pre-operative and post-operative 24 hour bladder diary. METHODS This was a retrospective study of men undergoing anterior urethroplasty for urethral stricture who completed a pre-operative and post-operative 24 hour bladder diary. Diaries done anytime prior to surgery and at least 1 month after surgery were included. Patients recorded the volume, time of void and degree of urgency of voids. Paired t-tests were performed on nocturnal voiding variables. RESULTS 18 men had preoperative and post-operative 24 hour bladder diaries. The mean age was 45.4 years (median 46.5,range, 26-70). 13 strictures were bulbar (72.2%), 4 pendulous-bulbar (22.2%), and 1 in the penile urethra (5.6%). Type of surgery included 6 (33%) buccal mucosa onlay grafts (5 dorsal, 1 ventral), augmented anastomotic repair, (n=2, 11.1%), and excision and primary anastomosis (n=10, 55.6%). Mean days from surgery to first post-operative 24 hour bladder diary was 287.5 days (median 109, range, 32-1116). Maximum voided volume increased after surgery (p = 0.02). Overall, nocturnal voiding parameters improved after urethroplasty and trended towards significance primarily by increases in functional bladder capacity measured by the maximum voided volume (mean preop 333ml, post-op 406.6, p=0.02), number of nightly voids (mean 1.8 to 1.2, p=0.07), and the nocturnal bladder capacity index (mean 1.2 to 0.8, p=0.13) and the correlation of the degree of urgency with the voided volume (Spearman's rho mean 0.5 to 0.6, p=0.09). Urethroplasty did not improve nocturnal voiding parameters by changes in urine production as measured by changes in the 24 hour voided volume, nocturnal urine volume, the nocturnal urine production rate or the nocturnal polyuria index. CONCLUSIONS Anterior urethral reconstruction improves nocturnal voiding parameters by improving functional bladder capacity. The maximum voided volume, actual night time voids, nocturnal bladder capacity index and Spearman's rho most significantly improved. This is the first study evaluating changes in nocturnal voiding function after urethroplasty. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e470-e471 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Rajveer Purohit More articles by this author Jyoti D. Chouhan More articles by this author frank copeli More articles by this author Dennis Robins More articles by this author Andrew Tam More articles by this author Jeffrey P Weiss More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The impact of nocturnal polyuria in older people with nocturnal LUTS.

Bladder dysfunctions often express the presence of lower urinary tract symptoms (LUTS) and are common in older people. The aim of this study was to analyze the micturition, incontinence and residual in older subjects, evaluating the role of nocturnal polyuria. Eighty-six patients aged 65 or older with invalidating LUTS were hospitalized for 24 hours. The maximum bladder capacity, mean micturition volume, post voiding residual and incontinence volume were recorded and analyzed day-time and night-time. Three groups were defined, i.e. nocturia, nocturnal incontinence and nocturnal polyuria (NP), and patients with or without NP were analyzed. With a majority of female patients 85% and a mean age of 74.3±5.96 years, a high incidence of nocturia (76%) was observed. NP was associated with nocturia in 56 patients (86%). In the three groups, the maximum bladder capacity and mean micturition volume were statistically higher during the night. Patients with nocturia or nocturnal incontinence associated to NP presented with a higher nocturnal maximum bladder capacity and mean micturition volume. A higher nocturnal post-void residual (PVR) was observed in patients with Nocturnal Incontinence associated with NP (P=0.03). Patients without NP presented significantly higher diurnal results. Nocturnal LUTS in older people is the result of a high nocturnal urine production related to NP with a higher nocturnal bladder capacity. The analyses of micturition, incontinence and PVR, and the accurate evaluation of the presence or absence of NP seems to be the key point for a better therapeutic choice in patients suffering by Nocturnal LUTS.

Alarme noturno e enurese: uma revisão baseada na evidência

Introduction: Nocturnal enuresis is a common problem, affecting about 15% of children between the ages of five and six years. Different treatments have been studied in order to diminish the potentially stigmatizing impact of NE, both for the child and the family. These include nocturnal alarms and behavior modification affecting sleep. Aim: The aim of this review was to assess the evidence for the effectiveness of nocturnal alarms in the treatment of nocturnal enuresis. Methods: A bibliographic review of international databases was conducted, using the MeSH terms ‘Nocturnal enuresis’ AND ‘Clinical alarms’. We also consulted the Index RMP database using the search terms Enurese noturna and Alarme. We selected meta-analyses, systematic reviews, randomized controlled trials, observational studies, and clinical guidelines written in Portuguese and English that were published between January 2005 and January 2015. The Oxford Centre for Evidence-Based Medicine criteria were used to establish the Level of Evidence (LE). Results: From a total of 52 articles found, nine met the inclusion criteria. These included three systematic reviews, three clinical trials, and three guidelines. Most studies found that NA is more beneficial than other non-pharmacologic options. When compared to desmopressin, the use of NA has shown equivalent effectiveness. Its use is associated with less risk of relapse and a better response when NE occurs due to diminished nocturnal bladder capacity. However, beneficial results take longer to appear with NA, parental collaboration is needed, and there is a risk of decreased adherence to this treatment. Clinical guidelines agree with the results of published trials. Discussion: Given the potential benefits of nocturnal alarms in the treatment of nocturnal enuresis (Level of Evidence 1, Strength of Recommendation A), the family doctor should consider this treatment for NE resistant to initial measures, thus avoiding the need for pharmacologic intervention or premature referral.