Nocturnal Bladder 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

Correction of nocturia in patients with benign prostatic hyperplasia. Mini-review and analysis of clinical observations

Aim. To outline the importance of nocturia in benign prostatic hyperplasia (BPH) and justify the feasibility and clinical need for antidiuretic therapy in these patients. Materials and methods. This article is a literature review. PubMed, Embase, and eLibrary databases were used for the search. Relevant publications were included in the literature review. The pilot study included 20 male patients aged 58–75 years with a confirmed diagnosis of BPH. Patients were divided into two groups: standard therapy (Tamsulosin Canon) and combined therapy (Tamsulosin Canon + Nourem). Diurnal diuresis was assessed based on the results of the Zimnitsky test and the nocturnal bladder volume index before and after treatment. Results. During standard therapy, patients had a decrease in the severity of obstructive and irritative symptoms and an improvement in the QoL index (p0.05). However, there was no significant improvement in nocturia. In the combined therapy group, the severity of symptoms significantly decreased by 53.3%, and the QoL index improved by 62.5%. On average, the sleep duration increased by 1.5 hours with almost unchanged rates of daily diuresis. Conclusion. The study showed that in 65% of patients, nocturia was caused not by anatomical and functional changes in the prostate and lower urinary tract but by nocturnal polyuria. Its management has a major role in nocturia treatment. The only pathogenesis-based treatment is the antidiuretic therapy (desmopressin) added to the α1-blocker.

NITES, a nocturnal bladder score to aid diagnosis during the transition to older age care.

As adults transition to older age, bothersome nocturnal lower urinary tract symptoms (LUTS) become common. There is need for a reliable assessment metric to detect and measure specific symptoms. To subject the nocturnal LUTS score for older individuals, Nocturia, Incontinence, Toileting and Enuresis Symptom Score (NITES), to psychometric analysis. Factor analysis of the metric was conducted with completed questionnaires from 151 older individuals who were either admitted to a tertiary hospital or attending an outpatient continence clinic. Test re-test reliability involved 18 older community dwelling individuals attending a Geriatrician clinic completing the metric at two timepoints separated by at least 1 week. Intra-class correlation coefficients were determined for reliability of each factor and item. The NITES metric was completed by 98 hospitalized older individuals and 53 attending a continence clinic (mean age 83.2 years [SD 7.0]). Factor analysis demonstrated that one item had a floor effect and two items had poor endorsement. After test re-test reliability analysis, a further three items were removed: one due to poor correlation between timepoints and two demonstrating inadequate internal consistency. The final NITES metric is comprised of three factors: Sleep 4-items, Incontinence 4-items, and Personal Bother 2-items. A 4-item short form for symptom screening was extracted from the longer measure. The final NITES metric is a 10-item questionnaire with an embedded 4-item short symptom screen. It has utility utilized to detect nocturnal bladder symptoms in both community dwelling and hospitalized older adults.

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.

A Prospective Study to Explore the Association Between Psychogenic Causes and Nocturnal Enuresis in Paediatric Age Group, Using Perceived Stress Scale - Children

Nocturnal enuresis is diagnosed when there is bedwetting after 5 years of age or anytime after 1 year of attaining nocturnal bladder control. It's a regressive behaviour. Regressive behaviours are a psychological defence mechanism in individuals going through trauma or stressful life situations. The purpose of this study is to establish the cause-effect relationship between psychogenic stress and nocturnal enuresis. Methods: 40 patients of both sexes, between 6-18 years of age were chosen, screened for nocturnal enuresis through the Nocturnal enuresis parent questionnaire and then the children were asked to fill Perceived Stress Scale - Children(PSS-C) and severity of stress was assessed in all the children, with and without enuresis. Result: 14 of the 40 cases, i.e., 35% with nocturnal enuresis also had a psychogenic stress factor. 17.5% had psychogenic stress factors but didn’t have nocturnal enuresis. 15% with enuresis didn't have any stress factors. Conclusion: This study proves that psychogenic causes play a major role in nocturnal enuresis and other regressive behaviour. Keywords: Nocturnal Enuresis, Stress, Regressive behaviour, Pediatrics, Homoeopathy, Psychology

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.

MP74-08 THE EFFECT OF NOCTURNAL DIURESIS ON BLADDER STORAGE DYSFUNCTION FOR MALE LUTS PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP74-08 THE EFFECT OF NOCTURNAL DIURESIS ON BLADDER STORAGE DYSFUNCTION FOR MALE LUTS PATIENTS Kanako Matsuoka, Kei Yaginuma, Yu Endo, Yuki Harigane, Yuta Matsuoka, Yuki Yoshida, Hitomi Imai, Akifumi Onagi, Seiji Hoshi, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, and Yoshiyuki Kojima Kanako MatsuokaKanako Matsuoka More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yu EndoYu Endo More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The causes of nocturia are often discussed separately as nocturnal urine volume and nocturnal bladder capacity problems. Since multiple factors affect nocturia, what affects it most has not been well investigated. We have been studying the bladder storage function as a homeostatic system keeps micturition interval constant by increasing the bladder capacity during the diuretic phase. We hypothesized that nocturnal diuresis could affect nocturnal urine volume and bladder storage function. This study aimed to identify the effect of nocturnal diuresis on bladder storage dysfunction for male patients with lower urinary tract symptoms (LUTS). METHODS: Male LUTS patients who were able to keep 24-h frequency-volume charts (FVCs) for 3 days were included in this study. Patients with residual urine volume greater than 200 mL were excluded. Patients who marked an average of two or more times per night on 3-days 24 h-FVCs were defined as the nocturia (+) group, and those who marked less than two times were defined as the nocturia (-) group. Patient characteristics and parameters of 24-h FVCs were compared between groups, with values of p<0.05 considered significant. RESULTS: The nocturia (+) group (n=52) was significantly older (p=0.01), had a higher nocturnal diuresis rate (p<0.001), and had a smaller voided volume at night (p=0.01) than the nocturia (-) group (n=48). Multivariate analysis showed that increased nocturnal diuresis rate and decreased nocturnal voided volume were significantly related to nocturia (nocturnal diuresis rate: OR 1.04, p<0.001; decreased nocturnal single voided volume: OR 0.985, p=0.001). Nocturnal diuresis was defined as a ratio of the mean diuretic rate at night to the mean diuretic rate during the day of 0.83 or greater (AUC 0.87, sensitivity 81.1%, specificity 79.2%). 17.6% of patients had nocturia with nocturnal diuresis without nocturnal bladder storage dysfunction (nocturnal voided volume <229.3 mL). Then, they had a significantly higher nocturnal diuresis rate than patients with nocturnal diuresis and nocturnal bladder storage dysfunction (p=0.03). CONCLUSIONS: Nocturnal diuresis is clearly associated with nocturia, but an extreme increase in nocturnal diuresis rate unexpectedly leads to increased nocturnal urine volume. Source of Funding: Nothing © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1072 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kanako Matsuoka More articles by this author Kei Yaginuma More articles by this author Yu Endo More articles by this author Yuki Harigane More articles by this author Yuta Matsuoka More articles by this author Yuki Yoshida More articles by this author Hitomi Imai More articles by this author Akifumi Onagi More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

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 ...

Enuresis and overactive bladder in sickle cell patients: a narrative review of the literature.

The aim of this review is to clarify the prevalence, pathophysiology and clinical presentation of enuresis and overactive bladder in sickle cell patients. This narrative review of the literature was conducted in March 2022 by running a search in PubMed, Embase, Scopus and Cochrane databases without publication date limitation, using the following keywords: enuresis or nocturia or overactive bladder or urinary incontinence or bedwetting and sickle cell. Eight cross-sectional studies were included, six of which had a non-sickle cell control population. The prevalence of enuresis in children and adolescents with sickle cell disease ranged from 20.3 to 49.4%. It decreased with age to 2.9% in adult sickle cell patients. Enuresis in sickle cell patients has been attributed to several causes, including lack of urine concentration with nocturnal polyuria, reduced bladder capacity, nocturnal bladder hyperactivity, sleep and/or respiratory disorders are likely causes of enuresis in sickle cell patients. The prevalence of overactive bladder is three times higher in sickle cell patients than in control groups. The latter is also observed three times more frequently in men who have had prior episodes of priapism. Enuresis and overactive bladder are common in sickle cell patients. Several mechanisms have been described to try to explain enuresis in sickle cell patients but overactive bladder seems to play a major role. Studies evaluating the efficacy of certain experimentally validated treatments must be carried out to improve the management of these complications which affect the quality of life of sickle cell patients.

Evaluation of bladder function and sleep patterns in children with primary mono-symptomatic nocturnal enuresis by polysomnography combined with ambulatory urodynamic monitoring

Objective: To evaluate the bladder function and sleep pattern in the children with primary mono-symptomatic nocturnal enuresis (PMNE) by the polysomnography (PSG) and ambulatory urodynamic monitoring (AUM). Methods: From October 2019 to October 2021, forty-three patients with PMNE were selected as PMNE group from the First Affiliated Hospital of Zhengzhou University and further subdivided into the severe PMNE group (enuresis>4 times/week) and the non-severe PMNE group (enuresis times 4 times/week) according to the severity. The conventional urodynamics (CUD), AUM, and PSG examinations and bladder diary were completed in the PMNE group. The control group consisted of 23 children with normal PSG findings and without the lower urinary tract symptoms. Results: The severe PMNE group included 9 males and 14 females, aged(12.1±3.2)years, and nocturnal enuresis number per week is 6.7±1.7. The non-severe PMNE group included 9 males and 11 females, aged(12.0±3.4)years, and nocturnal enuresis number per week is 2.3±1.0. The incidences of nocturnal polyuria and the reduction in maximum bladder capacity in the PMNE group was 34.9% and 11.6%, respectively. The incidence and frequency of detrusor overactivity (DO) in the severe PMNE group were significantly higher than those in the non-severe PMNE group [78.3% vs 45.0%, (5.5±1.8) times/h vs (3.4±1.0) times/h, respectively, all P<0.05]. It was found by the PSG that the severe PMNE group had significantly higher cortical arousal index, apnea hypopnea index (AHI), and percentage of N1+N2 phase in total sleep time, compared with the control group[(58.6±9.8)% vs (49.3±9.5)%, (9.4±4.4) times/h vs (3.1±1.5) times/h, (2.7±0.9) times/h vs (0.9±0.7) times/h] (all P<0.05). While the sleep efficiency of the severe PMNE group was substantially lower than that of the non-severe PMNE group [(86.4±4.3)% vs (91.0±3.9)%], the cortical arousal index and AHI were significantly greater than those of the non-severe PMNE group[(9.4±4.4) times/h vs (5.7±3.2) times/h, (2.7±0.9) times/h vs (1.9±0.7) times/h] (all P<0.05). In the PMNE group, there were positive correlations between cortical arousal index and nocturnal DO frequency or AHI (r=0.705, 0.765, P=0.001). Conclusions: Children with PMNE have nocturnal bladder dysfunction and abnormal sleep pattern, and there is a certain correlation between them. PSG and AUM are necessary for the evaluation and treatment of children with PMNE.

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.

Correspondence of uroflowmetry and voiding diary in evaluation of voiding volume in children with lower urinary tract dysfunction

BackgroundObjective assessment of voided volumes in children with lower urinary tract dysfunction is important. This study aimed to compare and evaluate voided volumes obtained from a 48-h voiding diary and uroflowmetry in children with lower urinary tract dysfunction.MethodsIn this retrospective cohort study, voided volumes obtained by 48-h voiding diary and contemporaneous uroflowmetry were compared in terms of age, sex, and the three most common subtypes of lower urinary tract dysfunction (monosymptomatic nocturnal enuresis, overactive bladder, and dysfunctional voiding) in children. Patients were stratified according to voided volume differences between uroflowmetry and 48-h voiding diary.ResultsA total of 242 children were included in the study. Maximum and average voided volumes in uroflowmetry were higher than those in 48-h voiding diaries in the entire population (P < 0.001). While there was a significant difference between maximum voided volume in the two methods when evaluating patients with overactive bladder and dysfunctional voiding, there was no significant difference in those with monosymptomatic nocturnal enuresis (P = 0.001, P = 0.030, P = 0.206, respectively). A significant difference was observed between the three subtypes of lower urinary tract dysfunction in voided volumes (P < 0.001). When maximum and average voided volumes were compared for age subgroups, there was no significant difference in maximum and mean voided volumes only in voiding diary measurements (P > 0.05). When the two methods were compared, there was a difference in maximum and average voided volumes of more than 30% of the estimated bladder capacity in 94 (38.9%) and 86 (34.3%) children, respectively.ConclusionsUroflowmetry and a 48-h voiding diary should not be used interchangeably when evaluating children with lower urinary tract dysfunction. The results of uroflowmetry measurements should be used to support the diagnosis of underlying lower urinary tract dysfunction.

A0642 - SENS-U: Continuous home monitoring of natural nocturnal bladder filling in children with nocturnal enuresis - a feasibility study

A0642 - SENS-U: Continuous home monitoring of natural nocturnal bladder filling in children with nocturnal enuresis - a feasibility study

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

Nocturnal bladder emptying and Quality of Life in patients with spinal cord injury.

Little is known about the relationship between sleep disruption due to nocturnal bladder emptying and Quality of Life in patients with spinal cord injury. The aim of this study was to evaluate the possible influence of number of nocturnal bladder emptying, bladder emptying method and nocturnal incontinence on the Quality of Life of patients with spinal cord injury. The design of this paper is a cross-sectional descriptive study. The setting is in- and outpatient. Seventy-nine patients aged between 18 and 77 years with SCI in a first rehabilitation period or follow-up. Patients were asked to complete Short Form-36 and Incontinence Quality of Life questionnaires and a medical information form. Independent samples t-tests and ANOVA were used to compare scores between groups. The response rate was 71 out of 79 (89%; 51 males and 20 females). 16 paraplegic and 4 tetraplegic patients were chronic, 29 paraplegic and 22 tetraplegic patients were in rehabilitation therapy or had finished this treatment recently. The paraplegic group had a significantly better Short Form-36 total score and emotional function score, while the tetraplegic group had a significantly better Incontinence Quality of Life total score and avoidance and limiting behavior score. The paraplegic patients with 0-1 nocturnal bladder emptying had better Short Form-36-derived Quality of Life than those with ≥2 emptying. Quality of Life score was not associated with gender, leg oedema, incontinence, or acute/chronic group. Incontinence Quality of Life score was significantly better for patients with incomplete spinal cord injury. Fully completed questionnaires were returned by 36 patients; at least 1 item was missing for 35 participants. General Short Form-36-derived Quality of Life was better for the paraplegic population. Incontinence-related Quality of Life was better in tetraplegic patients, most of whom used suprapubic catheterization. Paraplegic patients had compromised sleep and Quality of Life when the patient had to wake up two or more times at night to empty the bladder by voiding or intermittent catheterization. The high number of incomplete responders indicates the shortcomings of Quality-of-Life questionnaires for wheelchair-bound patients with spinal cord injury. The use of suprapubic catheterization should be considered to improve Quality of Life for tetraplegic patients. For paraplegic patients, we must focus urological policy on aiming to reduce the number of nighttime bladder emptying to one or none.

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.

626 - Establishment of nocturnal bladder control and behavioral sexual dimorphism in children

626 - Establishment of nocturnal bladder control and behavioral sexual dimorphism in children

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