Nocturnal Polyuria Research Articles

Chapter 21 - Nocturnal enuresis in children: The role of arginine–vasopressin

Nocturnal enuresis is the involuntary pass of urine during sleep beyond the age of 5 years. It is a common condition in childhood and has an impact on the child's well-being. Research into the pathophysiology of the condition in the last decades has led to a paradigm shift, and enuresis is no longer considered a psychiatric disorder but rather a maturation defect with a somatic background. An excess urine production during sleep is a common finding in children with enuresis and disturbances in the circadian rhythm of arginine-vasopressin (AVP) is found in the majority of children with nocturnal polyuria. Children with enuresis and nocturnal polyuria lack the physiologic increase in AVP levels during sleep and treatment with the AVP analogue desmopressin can restore this rhythm and lead to dry nights. The reasons for this aberrant circadian AVP rhythm are not established. Furthermore, not all children with enuresis and nocturnal polyuria can be successfully treated with desmopressin suggesting that factors beyond renal water handling can be implicated such as natriuresis, hypercalciuria, and sleep-disordered breathing. The advances in the research of the genetic background of the condition may shed further light on the enuresis pathophysiology.

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment.

This narrative review synthesizes current evidence on the medical management of nocturnal polyuria, including antidiuretic replacement therapy as well as other emerging modalities, with particular emphasis on areas of active investigation and future research directions. Relative to earlier formulations, the pharmacological profiles of novel desmopressin acetate nasal spray and orally disintegrating tablet formulations appear favorable in optimizing the balance between efficacy and safety. Additionally, several highly selective small-molecule arginine vasopressin 2 receptor agonists are under active development, while appropriately timed short-acting diuretics, pharmacotherapy for hypertension, nonsteroidal anti-inflammatory drugs, and sex hormone replacement therapy are also a focal point of extensive ongoing nocturnal polyuria research. Emerging laboratory technologies now make feasible a sub-stratification of nocturnal polyuria patients into substrate-based phenotypes for individualized treatment. An increasingly refined understanding of the pathogenesis of nocturnal polyuria, and arginine vasopressin dysregulation in particular, has also introduced new opportunities for point-of-care testing in patients with nocturnal polyuria.

Jingui Shenqi pill for nocturia due to nocturnal polyuria: A protocol for systematic review and meta-analysis.

Background:The incidence of nocturia is high and will seriously affect patients’ physical and mental health. Nocturnal polyuria is the most critical cause of nocturia, There are few drugs currently used to treat nocturia due to Nocturnal Polyuria (NP). The guide highly recommends only Desmopressin. There is an urgent need to find new drugs. Jingui Shenqi pill (JSP) is a Chinese patent medicine, it is widely used in China to treat NP. However, there is no evidence-based medical evidence to prove its safety and effectiveness. The purpose of this systematic review is to evaluate the efficacy and safety of JSP in the treatment of NP.Methods:We will search the randomized controlled trials (RCTs) including JSP for NP and published from the inception of the database to Oct 2020 by the following eight databases: Embase, Cochrane Library, PubMed, MEDLINE, the China National Knowledge Infrastructure, Cqvip Database, and Wanfang Data, the Chinese Biomedical Literature Database. There is no language and publication status restriction. The primary outcomes will include Nocturnal urine volume, the number of nocturnal voids, Nocturnal polyuria index (Nocturnal total urine volume /24 h total urine volume). We will perform the data synthesis, sensitivity analysis, subgroup analysis, and bias assessment risk using RevMan V.5.3. The reporting bias will be assessed using a funnel plot and Egger test.Results:This study may provide additional evidence of JSP for NP in the effectiveness and safety and alternative therapy for NP.Conclusions:In this systematic review, we will assess whether JSP is an effective and safe medicine for nocturia.

A large survey of nocturia related to sleep quality and daytime quality of life in a young Japanese population: NOCTURNE study.

Nocturia, due to nocturnal polyuria and other conditions associated with nocturnal voiding, affects sleep quality and daytime quality of life (QOL). We aimed to investigate the relationship among nocturia, sleep quality, and daytime QOL in a young Japanese population. This epidemiological study analyzed data from a retrospective data set containing sleep data from wearable devices worn by 9446 Japanese users and a prospective data set containing answers to a 10-item questionnaire completed by a subset of 605 users in the retrospective dataset. We recorded the first uninterrupted sleep period (FUSP), total sleep time (TST), number of nocturnal voids, sleep quality, daytime QOL, bothering nocturnal voids, and early wake-ups in the morning. The subjects were 18-65 years old. The mean TST was 6.7 ± 0.9 h, and the mean number of wake-ups was 2.11 ± 1.1. FUSP and TST decreased (from 334 ± 114 to 173 ± 74 min and 5.9 ± 1.0 to 5.5 ± 1.0 h, respectively) with an increasing number of nocturnal voids, and the change was statistically significant. Logistic regression analysis showed a statistically significant relationship between nocturia and FUSP and the number of wake-ups. Nocturia has close relationships with FUSP and the number of wake-ups and can result in decreased daytime QOL in young Japanese people.

Defining nocturnal polyuria in women

Nocturnal polyuria (NP) is defined by the International Continence Society (ICS) as "excessive production of urine during the main sleep period" and is one of the main causes of nocturia. The ICS recognized that "excessive" is not clearly defined and that this needs to be highlighted in both clinical and research settings. The aim of this study was to identify different definitions of NP and apply them to a population of women attending the Urogynaecology clinic. This was a retrospective study of complete bladder diaries collected from women attending a tertiary Urogynaecology Unit. Six different definitions were identified and were divided into "absolute," "relative," and "functional definitions." Prevalence data were calculated and values generated for sensitivity, specificity, positive and negative predictive values when related to women voiding ≥ 2 times per night. Complete bladder diaries were obtained from 1398 women, over 6 years, with a mean age of 57 years. Prevalence varied across the definitions from 21.5% (absolute definition) to 77% (relative definition). Sensitivity ranged from 43% (absolute) to 87% (relative). The definitions that showed the highest combined sensitivity and specificity were the functional definitions. From this study it is clear that more work needs to be done to arrive at a consensus for defining NP to enable accurate diagnosis and development of treatment pathways. We propose that a relative definition may provide a more clinically relevant method of defining NP.

Mechanisms and grading of nocturia: Results from a multicentre prospective study.

To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, and P<.05 was deemed as statistically significant. About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.

Nocturnal Urine Production in Women With Global Polyuria.

PurposeLow nocturnal urine production (NUP) may be sufficient to rule out global polyuria (GP) in men. This study determines the sensitivity of indices for nocturnal polyuria (NP), defined as nocturnal polyuria index (NPi; nocturnal urine volume/24-hour urine volume) ≥0.33 or NUP ≥90 mL/hr, for detecting GP in women.MethodsData were analyzed from 2 prospective protocols involving subjects recruited from a urology ambulatory care unit and a continence clinic. Women ≥18 years with nocturia were included if they met either of 2 common criteria for GP: (1) ≥40 mL/kg/24 hr or (2) ≥3,000 mL/24 hr.ResultsThirty-one women were included (NPi, 28.6 [21.3–40.7]; NUP, 100.8 [68.3–135.8] mL/hr). At the ≥40 mL/kg/24-hr cutoff, 40% and 63% of women reporting ≥1 nocturnal void(s) (n=30) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. Additionally, 53% and 71% of subjects reporting ≥2 nocturnal voids (n=17) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. At the ≥3,000 mL/24-hr cutoff, 38% and 69% of women reporting ≥1 nocturnal void(s) (n=13) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively, and 63% and 88% of subjects reporting ≥2 nocturnal voids (n=8) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. By extension, 37%–62% of women with nocturia and GP did not have NP by NPi ≥0.33 criteria, and 12%–37% did not have NP by NUP ≥90 mL/hr criteria.ConclusionsIndices of excess nighttime urination do not reliably predict GP in women. A full-length voiding diary may be particularly important in the evaluation of women with nocturia. Nocturia in women merits further consideration as a distinct entity.

Nocturnal enuresis: a practical approach in paediatrics

Nocturnal enuresis (NE) or bedwetting is the involuntary loss of urine during sleep. It's a common issue, with one in five children in Australia bedwetting. It drops off as the years progress to one in 10 children at 10 years, and one in 30-100 teenagers at 15-17 years. It's a common misconception that bedwetting is caused by a psychological problem; however, most often this is not the case. Often children have an inability to wake to the sensation of a full bladder; it's simply a skill they have not learnt yet. Other factors are constipation, an overactive bladder, poor bladder capacity, nocturnal polyuria, lack of the signal that stops bladder emptying during sleep, obstructive sleep apnoea, family history, and developmental issues. Careful assessment is important. Management needs to be tailored for all children and individual considerations need to be regarded. Some children will continue to wet through to teenage years and beyond into adulthood, although treatment with a continence nurse advisor will help the majority of children to improve or become dry.

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

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

Associations between nighttime and daytime maximum voided volumes: Relevance for nocturia?

The relationship between maximum voided volumes (MVV) during the night and day is poorly understood. Such measurements are important because they are often used to indicate functional bladder capacity (FBC), a relevant parameter for nocturia. This study examined the association of such nighttime and daytime measurements in men with nocturia. We retrospectively analyzed 356 24-hour voiding diaries showing ≥2 nocturnal voids from 220 men at an outpatient urology clinic. We defined small FBC as MVV ≤ 200 mL. A total of 131 entries demonstrated a nocturnal MVV ≤ 200 mL, of which a majority (98 [74.8%]) also showed a 24-hour MVV ≤ 200 mL (ie, global small FBC), and 33 (25.2%) exceeded the 200 mL threshold during the day (ie, nocturnal-specific small FBC). Correspondingly, among voiding diaries without global small FBC (n = 258), most (225/258 [87.2%]) showed a nocturnal MVV > 200 mL. Data were similar when analyzing only the first complete voiding diary per case, when limiting analyses to those without benign prostatic obstruction, and when limiting analyses to cases with nocturnal polyuria. Nocturia may be attributable to nocturnal-specific small FBC or global small FBC. Although the etiology of nocturnal-specific small FBC remains unclear, it was present in a significant minority of patients with small FBC, thus necessitating more directed research. Conversely, diminished nocturnal MVV was nevertheless relatively uncommon in the absence of global small FBC, such that nocturnal-only voiding diaries may provide a rational alternative for follow-up evaluation in patients with nocturia due to global small bladder capacity.

Cardiovascular risk independently predicts small functional bladder storage capacity.

We aimed to determine the potential relationship between atherosclerotic cardiovascular disease (ASCVD) score, which equates to 10-year risk of atherosclerotic cardiovascular events, and functional bladder capacity (FBC) among men in the outpatient urology setting. We secondarily analyzed voiding diaries from men aged 40 to 79years with nocturia. Patients with a history of cardiovascular disease or who had nocturnal polyuria were excluded. Patients were stratified by whether they met the high-risk ASCVD threshold (≥ 20%) following current cardiology consensus guidelines and assessed for the presence of small FBC (24-h maximum voided volume ≤ 200ml). Logistic regression analyses were employed to explore associations between small FBC and ASCVD. Eighty-four men (median ASCVD score 18.4 [IQR 12.8-26.9] %, age 66 [61-71] years, body mass index [BMI] 29.4 [26.4-32.7] kg/m2) were included, of whom 36 (42.9%) were high-risk and 48 (57.1%) fell below the high-risk threshold. High-risk patients were more likely to have small FBC (23 [63.9%] vs. 14 [29.2%], p = 0.002). ASCVD risk predicted small FBC on univariate analysis (p = 0.002). No such effect was observed with age (p = 0.116), BMI (p = 0.523), or benign prostatic obstruction (p = 0.180). The association between ASCVD risk and small FBC persisted on multivariate analysis after controlling for BMI and benign prostatic obstruction (p = 0.002). No significant predictors of small FBC were observed when age, a major determinant of ASCVD risk and independent correlate of small FBC, was substituted for ASCVD score (p = 0.108). Small FBC is related to a higher predicted cardiovascular event rate in men with nocturia.

Could Evening Dietary Protein Intake Play a Role in Nocturnal Polyuria?

Urea is the most abundant and the largest contributing factor for urine osmolality. Urinary urea excretion is highly interrelated with dietary protein intake. Accordingly, an increase of urinary urea excretion due to high protein diet may lead to urea-induced osmotic diuresis. This study aims to explore the association between nocturnal polyuria (NP) and urea. This is a post hoc analysis of a prospective observational study of subjects who completed a renal function profile between October 2011 and February 2015 (n = 170). Each subject underwent a 24 h urine collection, which included 8 urine samples collected at 3 h intervals. Urine volume, osmolality, creatinine, urea and sodium were determined. Urinary urea excretion was used to estimate dietary protein intake. Compared to the control group, subjects with NP exhibited significantly higher nighttime urea and sodium excretion. Estimated evening dietary protein intake was correspondingly significantly higher amongst the NP subgroup. Nighttime diuresis rate was positively associated with age and nighttime free water clearance, creatinine clearance, sodium excretion, and urea excretion in NP subjects. Therefore, increased nocturnal urinary urea excretion may reflect an additional important mediator of nocturia owing to excess nocturnal urine production.

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.

Assessment of the Most Impactful Combination of Factors Associated with Nocturia and to Define Nocturnal Polyuria by Multivariate Modelling.

Background: Nocturia is common and associated with multiple disease states. Many potential mechanisms have been proposed for nocturia, which also remains challenging to manage. Purpose: To use multivariate analysis to determine which combinations of factors can accurately discriminate clinically significant nocturia in patients to facilitate clinical management and treatment decisions. Patients and methods: Data analysis was based on frequency volume charts from three randomized controlled trials. There were 1479 patients included, of which 215 patients had no/mild nocturia and 1264 had clinically significant nocturia with at least two voids per night. Factors studied that may influence nocturia were demographics, sleep duration, functional bladder capacity, 24 h urine volume and literature-suggested definitions of nocturnal polyuria. We used univariate analysis and cross-validated multivariate modelling to assess association between factors and nocturia status, redundancy between factors and whether the combined use of factors could explain patients′ nocturia status. Results: The multivariate analyses showed that the most useful definitions of nocturia are ’Nocturia Index’ (NI) and ‘Nocturnal Urine Production per hour’ (NUPh) in combination with functional bladder capacity and sleep duration. Published definitions providing binary nocturnal polyuria outcomes had lower performance than continuous indices. These analyses also showed that NI was not specific to nocturnal polyuria as it also captured nocturia due to low functional bladder capacity. By contrast, NUPh was demonstrated to be specific to nocturnal polyuria. Conclusion: NUPh has previously been shown among elderly males to be essential in nocturia and a very valid measure of nocturnal polyuria. However, the current, large and independent dataset now confirms that it can be applied in an adult population with a complaint of nocturia covering both males and females.

Rationale, design, and methods of electroencephalography-based investigation of the effects of oral desmopressin on improving slow-wave sleep time in nocturnal polyuria patients (the DISTINCT study): protocol for a single-arm, open-label, single-assignment trial

BackgroundNocturia is one of the most bothersome lower urinary tract symptoms and often impairs sleep quality in the elderly. Although previous studies on nocturia have indicated that the successful treatment of nocturia improves sleep quality, most used questionnaires and activity devices to analyze sleep/wake patterns. Therefore, there is little information about the treatment effects of desmopressin on objective sleep quality. The aim of the DISTINCT study is to investigate the change in subjective and objective sleep quality using electroencephalography (EEG) and the Pittsburgh Sleep Quality Index (PSQI) after the administration of desmopressin in patients with nocturia due to nocturnal polyuria.MethodsA total of 20 male patients, ≥65 years old, with nocturnal polyuria, defined as a nocturnal polyuria index (NPi) (nocturnal urine volume / 24 h urine volume) value ≥0.33, will participate in this study. The participants must have a nocturnal frequency of ≥2 and the first uninterrupted sleep period (FUSP) must occur within < 2.5 h. Desmopressin 50 μg per day will be orally administered before going to bed for 4 weeks. Urinary frequency volume charts (FVC) and EEG will be recorded prior to treatment and at 1 week and 4 weeks after the initiation of treatment. The PSQI will be completed before and 4 weeks after treatment. The primary endpoint is the change from baseline in the mean time of slow-wave sleep (sleep stages N3 and N4) at 4 weeks. The secondary endpoints include the change in the mean value of each sleep variable, the mean delta power during the FUSP, the correlation between nocturnal urinary frequency and slow-wave sleep time, and the change in PSQI score before and after treatment.DiscussionThe DISTINCT study will provide valuable evidence to indicate that oral desmopressin treatment for nocturnal polyuria prolongs the FUSP, resulting in the extension of slow-wave sleep time associated with sleep quality.Trial registrationThe Japan Registry of Clinical Trials (jRCTs051190080). Registered 9 December, 2019.

Pediatric Pharmacology of Desmopressin in Children with Enuresis: A Comprehensive Review.

Desmopressin is a synthetic analogue of the natural antidiuretic hormone arginine vasopressin. Over the years, it has been clinically used to manage nocturnal polyuria in children with enuresis. Various pharmaceutical formulations of desmopressin have been commercialized for this indication-nasal spray, nasal drops, oral tablet and oral lyophilizate. Despite the fact that desmopressin is a frequently prescribed drug in children, its use and posology is based on limited pediatric data. This review provides an overview of the current pediatric pharmacological data related to the different desmopressin formulations, including their pharmacokinetics, pharmacodynamics and adverse events. Regarding the pharmacokinetics, a profound food effect on the oral bioavailability was demonstrated as well as different plasma concentration-time profiles (double absorption peak) of the desmopressin lyophilizate between adults and children. Literature about maturational differences in distribution, metabolism and excretion of desmopressin is rather limited. Regarding the pharmacodynamics, formulation/dose/food effect and predictors of response were evaluated. The lyophilizate is the preferred formulation, but the claimed bioequivalence in adults (200µg tablet and 120µg lyophilizate), could not be readily extrapolated to children. Prescribing the standard flat-dose regimen to the entire pediatric population might be insufficient to attain response to desmopressin treatment, whereby dosing schemes based on age and weight were proposed. Moreover, response to desmopressin is variable, whereby complete-, partial- and non-responders are reported. Different reasons were enumerated that might explain the difference in response rate to desmopressin observed: different pathophysiological mechanisms, bladder capacity and other predictive factors (i.e. breast feeding, familial history, compliance, sex, etc.). Also, the relapse rate of desmopressin treatment was high, rendering it necessary to use a pragmatic approach for the treatment of enuresis, whereby careful consideration of the position of desmopressin within this treatment is required. Regarding the safety of the different desmopressin formulations, the use of desmopressin was generally considered safe, but additional measures should be taken to prevent severe hyponatremia. To conclude the review, to date, major knowledge gaps in pediatric pharmacological aspects of the different desmopressin formulations still remain. Additional information should be collected about the clinical relevance of the double absorption peak, the food effect, the bioequivalence/therapeutic equivalence, the pediatric adapted dosing regimens, the study endpoints and the difference between performing studies at daytime or at nighttime. To fill in these gaps, additional well designed pharmacokinetic and pharmacodynamic studies in children should be performed.

Prevalence of the nocturnal polyuria syndrome in men.

Nocturnal polyuria (NP) is caused by a wide array of factors, including genitourinary and systemic comorbidities, modifiable behavior, and pharmaceuticals. When an identifying factor is absent, NP may be purely a symptom of the nocturnal polyuria syndrome (NPS) and secondary to blunting of normal arginine vasopressin action within the circadian rhythm. The purpose of this study is to determine the prevalence of NPS in male patients attending a Veterans Affairs outpatient urology clinic. Retrospective database analysis was performed of voiding diaries from men who had established care for lower urinary tract symptoms from 2007 to 2018. Patients were excluded if they reported fewer than two nocturnal voids on voiding diary analysis or had comorbidity associated with NP. Distinct cutoffs were separately employed to identify NP: nocturnal polyuria index (NPi; calculated as nocturnal urine volume divided by 24-hour urine volume) greater than 0.33; and nocturnal urine production (NUP) greater than 90 mL/h. A total of 283 completed voiding diaries were evaluated and 202 patients had ≥2 nocturnal voids. After exclusions, at NPigreater than 33, the floor and ceiling NPS prevalence values were 21% and 41%, respectively. At NUP greater than 90 mL/h, the floor and ceiling NPS prevalence values were 17% and 32%, respectively. The prevalence of NPS in patients with nocturia in the present study lies between 17% and 41%. NPS constitutes a clinically relevant subgroup of nocturia among male patients in the Veterans Affairs outpatient urology setting.

0823 Age-Related Changes in Nocturnal Urine Composition

Abstract Introduction In humans sleeping nocturnally, nocturnal polyuria (NP) refers to high rate of overnight urine production. NP is a heterogeneous condition that may reflect both free water and/or sodium diuresis, but the influence of age on differential fluid handling remains poorly understood. This study examined diuresis rate, sodium clearance, and free water clearance (FWC) by age, time of day (nighttime vs. daytime) and NP status (positive/negative) in subjects under entrained conditions sleeping nocturnally. Methods Convenience samples (age range 18-91; 82 men, 148 women) recruited from a urology ambulatory care unit (n=135) or continence clinic (n=95) collected 8 urine samples at 3-hour intervals over a single 24-hr period. Three separate mixed linear models were constructed for diuresis rate, sodium clearance, and FWC using four predictors: NP status (present [&amp;gt;90mL/h] vs. absent), time of day (night = 0100, 0400, 0700), age (as a continuous measure), and study source. Results Subjects with NP experienced both higher nighttime vs. daytime diuresis rate (1.89 vs. 1.44 mL/min, p&amp;lt;0.001), sodium clearance (0.91 vs. 0.74 mL/min, p&amp;lt;0.001), and FWC (-0.38 vs. -0.71 mL/min, p&amp;lt;0.001), whereas subjects without NP demonstrated lower nighttime vs. daytime diuresis rate (0.94 vs. 1.06, p=0.004) and no difference in sodium clearance (0.59 vs. 0.64, p=0.120) or FWC (-0.80 vs. -0.86, p=0.268). Regardless of NP status, FWC increased with age (p=0.039), and older age (&amp;gt;70) was accompanied by an increase in the ratio of nighttime/daytime diuresis rate and both nighttime and daytime sodium clearance. Conclusion Irrespective of NP, older adults experience proportionally greater nocturnal sodium clearance, as well as a complex surge in both daytime and nighttime FWC. The data imply that both nocturnal sodium clearance and FWC may reflect the relevant substrate underlying excess nocturnal urine production in elderly persons. Support N/A

Daily salt intake is associated with leg edema and nocturnal urinary volume in elderly men.

There is accumulating evidence that excessive salt intake contributes to nocturnal polyuria. We aimed to investigate the relationship between salt intake, leg edema, and nocturnal urine volume (NUV) to assess the etiology of nocturnal polyuria. A total of 56 men aged ≥60 years who were hospitalized for benign prostatic hyperplasia or with suspected prostatic cancer were enrolled. Urine frequency-volume charts of the patients were maintained, and they underwent bioelectrical impedance analysis twice daily (at 5:00 pmand 6:00 am) and examination of blood (brain natriuretic peptide levels) and urine (sodium and creatinine levels and osmotic pressure) samples once daily (at 6:00 am). Free-water clearance, solute clearance, and sodium clearance at night were measured, and daily salt intake was estimated. The data of 52 patients were analyzed. Daily salt intake positively correlated with leg edema at 5:00 pm, differences in leg extracellular fluid levels between 5:00 pmand 6:00 am, and NUV, but not with diurnal urine volume. Partial correlation coefficients showed that salt intake was a factor of the correlation between NUV and change in extracellular volume in the legs between 5:00 pmand 6:00 am. A multivariate logistic model showed that sleep duration and sodium clearance were independent predictive factors for nocturnal polyuria. Sodium intake correlates with diurnal leg edema and NUV in elderly men. These results provide evidence supporting sodium restriction as an effective treatment for nocturnal polyuria.

Aproximación diagnóstica y terapéutica de la nocturia en Atención Primaria

Nocturia is the interruption of the main sleep, one or more times, due to the need for urination. It is associated with a decrease in the quality of life and an increase in mortality. It is a complex and multifactorial symptom in which two pathophysiological mechanisms are mainly involved. These occur alone or in combination as nocturnal polyuria or decreased bladder capacity. Nocturnal polyuria is the most frequent. The preparation of a bladder diary is the key to diagnosis. Treatment usually combines lifestyle changes and drug therapy. Desmopressin has proven to be an effective and well-tolerated treatment in patients with nocturnal polyuria. The risk of hyponatraemia should be controlled in patients treated with desmopressin.