Nocturnal Urine Output Research Articles

Do independent geriatric outpatients with nocturnal polyuria profit from desmopressin?

To compare the efficacy of desmopressin and placebo in independent geriatric outpatients with nocturnal polyuria (NP). A prospective, randomized, single-center, national, double blind, placebo-controlled, fixed-dose, parallel group comparative trial was carried out. The study included 110 geriatric outpatients, 55patients per treatment group using desmopressin acetate nasal spray (strength: 0.1 mg/ml) once daily of 10 μg/spray blast or placebo. The NP positive geriatric outpatients with >33% nocturnal urine output volume, antidiuretic hormone (ADH) positive or negative were treated over 10days with intranasal spray in the evening time (7p.m.), drug or placebo. On day1 voiding frequency, voiding volumes day and night, serum osmolarity and arginine-vasopressin (AVP) were measured at 7p.m. On days2, 5 and 10 creatinine, blood urea nitrogen (bun), blood count and C‑reactive protein (CrP), vena cava diameter and bioimpedance were measured and astructured interview was implemented (voiding frequency, sleeping behavior and subjective and cognitive behavior). The NP patients showed amean night voiding volume of 50.60%, 39.21% (n = 102) showed alow AVP level at baseline with no correlation to sodium concentration or voiding frequencies. The primary efficacy criterion, a decrease of the nocturnal voiding frequency during the course of the clinical trial as change from baseline at day10 (visit4) was 50% versus 41.40% in the verum versus placebo group, respectively but the differences were not significant. The U‑test showed superiority of AVP-positive NP patients to a positive reaction on desmopressin. Sleeping time hours increased in both groups without significant differences. In this 10-day clinical trial desmopressin was not proven to be therapeutically superior to placebo with respect to micturition frequency or sleeping hours. Independent geriatric outpatients with decreased ADH levels seemed to respond and benefit from active treatment with desmopressin. The unexpected results in the placebo group may be due to the effect of intensive outpatient care and information on NP outpatients with normal AVP levels.

Pathophysiology of nocturnal lower urinary tract symptoms in older patients with urinary incontinence.

To explore the mismatch between functional bladder capacity and nocturnal urine production, and to study the pathophysiology of an increased nocturnal urine production in older patients with urinary incontinence. The present prospective observational study included adults aged ≥65years with urinary incontinence. Participants completed questionnaires, frequency volume charts and renal function profiles. The nocturnal lower urinary tract symptom index was defined as nocturnal urine output/maximum voided volume; the nocturnal polyuria index as nocturnal/24h urine output. The median age (n=95) was 74years (69-79), 87% were women and 73% had nocturnal lower urinary tract symptoms (nocturnal urinary incontinence or nocturia ≥2). Participants with nocturnal lower urinary tract symptoms had a significantly higher nocturnal urine output (809mL vs 650mL; P=0.001) and no significant difference in maximum voided volume (350mL vs 437mL; P=0.079) compared with participants without nocturnal lower urinary tract symptoms. Participants (nocturnal polyuria index >33% [n=56], nocturnal polyuria index >40% [n=42], nocturnal lower urinary tract symptom index >1.87 [n=51]) showed higher night-time diuresis rates, free water and sodium clearance compared with during the daytime. Controls (nocturnal polyuria index ≤33% [n=26], nocturnal polyuria index ≤40% [n=40], nocturnal lower urinary tract symptom index ≤1.87 [n=44]) had no circadian rhythm in their diuresis rate or sodium clearance, but more nocturnal free water clearance compared with during the daytime. The majority of older adults with urinary incontinence present nocturnal lower urinary tract symptoms. An increased nocturnal sodium diuresis seems to be the only mechanism differentiating patients with nocturnal lower urinary tract symptoms from controls.

Does desmopressin produce more cognitive problems and delirious symptoms in independent geriatric outpatients with nocturnal polyuria (NP)?

ObjectivesTo show a relation between the nocturnal polyuria, its therapy with desmopressin and cognitive alterations and delirious symptoms. MethodologyProspective, randomized, mono-center, mono-national, double-blind, placebo-controlled, fixed-dose, parallel group comparative trial, with 110 patients, 55 patients per treatment group using desmopressin acetate nasal spray, strength: 0.1mg/mL, nasal once a day of 10μg/spray blast. MeasurementNP positive patients (>33% nocturnal urine output volume [ADH positive or negative]) were treated over 10 days with intranasal spray in the evening time (7 p.m.), drug or placebo. On day 2, 5 and 10 the patients were interviewed about voiding frequency, sleeping behavior and subjective and cognitive alterations and delirium. ResultsThere was no correlation to be found between NP and the incidence of delirious symptoms or cognitive alterations. But the Mann-Whitney U-Test showed a superiority for delirious symptoms and forgetfulness under effective treatment with desmopressin (P=0.0279). Delirious symptoms showed to be significantly more frequent under desmopressin treatment in the final assessment (results last value, P=0.0297; changes from baseline, P=0.0340; percentage changes from baseline, P=0.0373). The variance analysis with repeated measures approved no significant augmentation of delirious symptoms under desmopressin. ConclusionIn this 10-day, clinical trial desmopressin was not significantly correlated with more delirious symptoms and forgetfulness in independent geriatric outpatients. NP and the disturbance of sleep were not correlated with delirium or cognitive decline.

MP63-14 OVERNIGHT AMBULATORY URODYNAMICS FINDINGS IN PATIENTS WITH NOCTURIA AND/OR NOCTURNAL ENURESIS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2017MP63-14 OVERNIGHT AMBULATORY URODYNAMICS FINDINGS IN PATIENTS WITH NOCTURIA AND/OR NOCTURNAL ENURESIS Eskinder Solomon, Megan Duffy, Sachin Malde, Hazel Ecclestone, Mahreen Paksad, Rizwan Hamid, Tamsin Greenwell, and Jeremy Ockrim Eskinder SolomonEskinder Solomon More articles by this author , Megan DuffyMegan Duffy More articles by this author , Sachin MaldeSachin Malde More articles by this author , Hazel EcclestoneHazel Ecclestone More articles by this author , Mahreen PaksadMahreen Paksad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1966AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nocturnal symptoms are very troublesome to patients, yet objective methods to assess night time bladder function are limited. We aimed to determine the prevalence of detrusor overactivity in patients with nocturia and nocturnal enuresis during overnight ambulatory urodynamics METHODS Twenty patients whose most bothersome symptoms were nocturia and/or nocturnal enuresis underwent overnight ambulatory urodynamic studies. All patients had undergone prior undiagnostic standard filling cystometry. Traces were reviewed and it was documented if detrusor overactivity (DO) +/-leakage was demonstrated, as well as the maximum voided volume and nocturnal urine output. RESULTS The mean ( SD) agewas 45.1 ± 19.9 years, comprising 14 female and 6 male patients All patients presented with nocturia with 17 patients additionally complaining of nocturnal enuresis. Only 5 patients reported bothersome day time symptoms. The mean duration for the overnight ambulatory urodynamic studies was 14.5 hours (range 12 to 16.6 hours). DO was demonstrated in 80% (n=16) of patients. 15 out of the 17 (88.3%) patients with nocturnal enuresis demonstrated DO. Small volume SUI was demonstrated in 4 out the 17 (23.5%) patients with nocturnal enuresis. The mean and median peak DO pressure was 68.3 (± 50.9) and 50 cmH2O. There appears to be no significant difference in the maximum voided volume and nocturnal urine output between the two DO groups (NB: small sample DO -ve patients). Incontinence was observed in 15 out of 16 (93%) patients with DO. CONCLUSIONS 80.0% of patients who present with nocturia and 88% with nocturnal enuresis demonstrate detrusor overactivity on overnight ambulatory urodynamics tests. The DO pressures demonstrated were large amplitude and resulted in incontinence by overcoming in most cases an otherwise competent outlet. Nocturnal ambulatory urodynamics are a useful clinical adjunct for assessing night time urinary symptoms. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e840-e841 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Eskinder Solomon More articles by this author Megan Duffy More articles by this author Sachin Malde More articles by this author Hazel Ecclestone More articles by this author Mahreen Paksad More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Combination treatment of nocturnal enuresis with desmopressin and indomethacin.

We investigated the effect of combining indomethacin and desmopressin in treating children with monosymptomatic nocturnal enuresis (MNE) and desmopressin-resistant nocturnal polyuria. Twenty-three children with MNE, nocturnal polyuria, and partial or no response to desmopressin were recruited from incontinence clinics of our tertiary referral center. We used a randomized single-arm crossover placebo-controlled study design consisting of two 3-week treatment periods with a combination of desmopressin (0.4mg) and indomethacin (50mg) or desmopressin and placebo at bedtime. Home recordings at baseline and for the final 2weeks of each treatment period were performed and included nocturnal urine output measurements. The number of dry nights achieved and reduction in the nocturnal urine output were the main effect parameters. Student's t test and Pearson's correlation coefficient were used for statistical analysis. The addition of indomethacin to desmopressin significantly reduced nocturnal urine output (from 324 ± 14ml to 258 ± 13ml, p < 0.001). This did not lead to more dry nights in all children, and we found no statistically significant reduction in enuresis frequency (from 68% ± 0.1 to 56% ± 0.1, p = 0.24). Addition of indomethacin to desmopressin can further reduce nocturnal urine output in children with MNE and desmopressin-resistant nocturnal polyuria. The combination treatment does not, however, improve outcome in terms of frequency of nights with enuresis. The dissociation of antidiuretic and antienuretic effect may reflect nocturnal bladder reservoir dysfunction in children who present with normal daytime bladder function.

Clinical efficacy and safety of doxazosin combined with desmopressin in treatment of nocturia in patients with benign prostatic hyperplasia

Thirty six patients aged 50-70 years with benign prostatic hyperplasia (BPH) received doxazosin and desmopressin treatment for 4 weeks. After treatment the International Prostate Symptom Scores (IPSS)and Quality of Life (QoL) scores of patients were significantly improved (17.4±2.5 vs. 11.8±1.1 and 3.9±0.6 vs. 1.8±1.3, respectively; both P<0.01). The nocturia frequency was decreased from 4.6±1.5 to 2.1±1.6 (P<0.01); nocturnal urine output from (564±73) to (348±45) ml (P<0.05); the hours of undisturbed sleep increased from (88.6±17.5)min to (146.2±12.8)min (P<0.05). There were no significant differences in serum levels of sodium, potassium and chlorine, and osmoticpressure before and after treatment. The results indicate that doxazosin combined with desmopressin is safe and effective for treatment of nocturia in patients with BPH. Key words: Deamino arginine vasopressin; Nocturia; Prostatic hyperplasia

Nocturnal polyuria and decreased serum testosterone: Is there an association in men with lower urinary tract symptoms?

To investigate the putative association between nocturia and decreased serum testosterone in men with lower urinary tract symptoms. Frequency volume charts and serum testosterone levels of patients visiting the outpatient clinic for lower urinary tract symptoms were collected and analyzed. Age, prostate volume, body mass index and the presence of comorbidities were accounted for. Frequency volume charts were analyzed for pathophysiological components of nocturnal polyuria, global polyuria, decreased nocturnal bladder capacity and increased frequency to identify associated risks. Frequency volume charts were also used to chart 8-h changes of volume, frequency and capacity to identify time diurnal interactions with risk factors based on serum testosterone levels. A total of 2180 patients were enrolled in the study. Multivariate analysis showed testosterone decreased 0.142 ng/mL for every increase in nocturia, independent of other factors. Logistic regression analysis showed a significant difference between pathophysiological components. Decreased testosterone was shown to carry a significant independent risk for overall nocturia (odds ratio 1.60, 95% confidence interval 1.013-2.527, P = 0.044), and particularly nocturnal polyuria (odds ratio 1.934, 95% confidence interval 1.001-3.737, P = 0.027). Repeated measurement models showed patients with serum testosterone below 2.50 ng/mL to have a paradoxical increase in nocturnal urine volume at night. Nocturia, especially nocturnal polyuria, is associated with decreased serum testosterone. Patients with low serum testosterone show increased nocturnal urine output.

Reply

The exact etiology of nocturnal enuresis (NE) is unknown. But there are some suspected situations, such as developmental delay of antidiuretic hormone production at night, developmental delay of appropriate arousal thresholds, and nocturnal detrusor over-activity. 1 Rasmussen P.V. Kirk J. Borup K. et al. Enuresis nocturna can be provoked in normal healthy children by increasing the nocturnal urine output. Scand J Urol Nephrol. 1996; 30: 57-61 Crossref PubMed Scopus (20) Google Scholar , 2 Rittig S. Knudsen U.B. Norgaard J.P. et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. 1989; 256: F664-F671 PubMed Google Scholar , 3 Wolfish N.M. Pivik R.T. Busby K.A. Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr. 1997; 86: 381-384 Crossref PubMed Scopus (152) Google Scholar , 4 Yeung C.K. Chiu H.N. Sit F.K. Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol. 1999; 162 (discussion 1054-5): 1049-1054 PubMed Scopus (167) Google Scholar Underlying factors may change from one patient to another. This causes the treatment choice to differ, especially in the first evaluation of the patient. We value the editorial comments and would like to emphasize that the primary purpose of our report was to evaluate copeptin's role in the etiology of NE. Copeptin is more stable than arginine vasopressin (AVP) and reflects more stable plasma concentrations. We observed that copeptin levels decrease more significantly with increasing severity of the disease and a positive family history. Hence, in this group of patients, AVP deficiency at night may be the primary cause for NE, and these patients may benefit from desmopressin therapy much more than other patients. We agree with the editor that our study has some limitations. But this is a preliminary study, and by taking this study as a basis, further studies can be carried out with a greater number of patients and by measuring copeptin and AVP levels in the mornings and at nights and comparing desmopressin treatment outcomes according to copeptin levels thereby proving the marker's efficacy in clinical use. Editorial CommentUrologyVol. 82Issue 5PreviewWe know that primary monosymptomatic nocturnal enuresis (MNE) is a symptom of a multifactorial disease – insufficient arousal mechanism, smaller than expected bladder capacity, or nocturnal polyuria, or a combination of these, are some etiologies identified to date.1-3 Full-Text PDF

Effect of Indomethacin on Desmopressin Resistant Nocturnal Polyuria and Nocturnal Enuresis

We evaluated the acute effect of indomethacin on renal water and solute handling in children with coexisting monosymptomatic nocturnal enuresis and desmopressin resistant nocturnal polyuria, and in healthy controls. A total of 23 subjects were recruited, consisting of 12 children with monosymptomatic nocturnal enuresis and nocturnal polyuria with partial or no response to desmopressin, and 11 age matched controls. Children completed a 48-hour inpatient study protocol consisting of fractional urine collections and blood samples. Sodium and water intake were standardized. During the second night a dose of 50 mg indomethacin was administered orally before bedtime. Diuresis, urine osmolalities, clearances and fractional excretions were calculated for sodium, potassium, urea, osmoles and solute-free water. Renin, angiotensin II, aldosterone and atrial natriuretic peptide were measured in plasma. Prostaglandin E(2) was measured in urine. Indomethacin markedly decreased the nocturnal sodium, urea and osmotic excretion in children with enuresis and controls. The overall effect on nocturnal urine output was inconsistent in the group with enuresis. Subjects in whom nocturnal diuresis was decreased following administration of indomethacin remained dry. Prostaglandin inhibition leads to antidiuresis, reducing the amount of sodium, urea and osmotic excretion in children with monosymptomatic nocturnal enuresis and desmopressin resistant nocturnal polyuria. The sodium regulating hormones do not seem to mediate these processes. The overall effect in desmopressin nonresponders with nocturnal polyuria is variable. The extent to which indomethacin can be applied in the treatment of enuresis needs further evaluation.

Clinical analysis of low does oral Desmopressin in treatment of nocturia in elder women

Objective To investigate the efficacy and safety of low dose of oral desmopressin in elderly women with nocturia. Methods Eligible female patients with nocturia older than 60 years were included in this study.A total of 97 patients were randomly divided into 2 groups.Care was taken to match the patients of the two groups by age and clinical criteria.Control group (n=48 ) received liquid restriction during nighttime.Experimental group (n=49) received 0.1 mg desmopressin at bedtime and liquid restriction for 8 weeks.Patients were required to visit the outpatient clinic from the first visit,and after 4 and 8 weeks of treatment.Patients maintained flow volume charts and used diaries to record voiding data throughout the study.At each visit,all patients were evaluated by blood biochemical routine test,mean nocturnal urine volume,mean number of nocturia,mean duration of the first sleep period and sleep quality.At baseline,all the patient's blood sodium,liver and kidney function were normal. Results After 4 weeks of treatment with desmopressin,28 patients (57.1％) had less than 2 voids.15 patients (31.3％) in the control group had less than 2 voids.After 8 weeks,35 patients (71.4％) with desmopressin had less than 2 voids.16 patients (33.3％) in the control group had less than 2 voids.Compared with control group,nocturia cure rate in experimental group was significantly higher after 4 weeks and 8 weeks (P ＜ 0.05).After 8weeks,desmopressin significantly decreased mean nocturnal urine output from 590 ± 70 ml to 376 ± 50 ml (P ＜ 0.05).Mean nocturnal urine output in the control group was not significantly decreased from 600 ± 90 ml to 550 ± 60ml (P ＞0.05) ; Mean number of nocturia before and after receiving desmopressin were 2.9 and 1.6 respectively which differed significantly (P ＜ 0.05).Mean number of nocturia before and after in control group were 2.8 and 2.3 respectively with no significant difference (P ＞ 0.05).The mean duration of the first sleep period increased by 73％ (from 2.2 to 3.8 h) in the desmopressin group,compared with an increase of 19％ (from 2.1 to 2.5 h) in the control group (P ＜ 0.05).39 (79.6％) patients in demopressin group were satisfied with sleep quality compared with only 15 (31.3％) patients in control group were satisfied (P ＜ 0.05).No serious complications were found during the medication.All the patient's blood sodium,liver and kidney function remained normal during treatment. Conclusions Low does oral administration of desmopressin could be an effective and well-tolerated treatment for nocturnal polyuria in elderly women. Key words: Aged; Women; Desmopressin; Nocturia; Treatment

Reduced anti-diuretic response to desmopressin during wet nights in patients with monosymptomatic nocturnal enuresis

ObjectiveTo investigate why not all children with monosymptomatic nocturnal enuresis (MNE) treated with desmopressin give an adequate response. Materials and methodsWe included 114 children with MNE aged 5–15 years (9.8 ± 0.2 years) who experienced at least 1 wet night and more than 2 dry nights during desmopressin treatment. The patients made home recordings for 2 weeks as baseline and for 2–4 weeks of desmopressin titration. Nocturnal urine production during wet and dry nights, and maximum voided volumes (MVVs) were documented in all patients. ResultsSixty-four patients were desmopressin non-responders, 29 were either partial responders or responders, while 21 patients were full responders. Desmopressin reduced nocturnal urine production dramatically during dry nights compared with pre-treatment wet nights. Nocturnal urine production during desmopressin treatment was significantly greater during wet nights compared to dry nights (243 ± 9.32 vs 176 ± 5.31 ml, P < 0.001). There was a highly significant correlation between individual nocturnal urine output and MVV, and dry nights were characterized by nocturnal urine output/MVV ratios well below 1.0. ConclusionThe anti-enuretic response to desmopressin seems to be dependent upon the degree of reduction in nocturnal urine production. Research on desmopressin bioavailability in children is needed.

Effect of Laser Acupuncture for Monosymptomatic Nocturnal Enuresis on Bladder Reservoir Function and Nocturnal Urine Output

The alternative treatments for enuresis have been reported with high efficacy but in noncontrolled studies. Therefore, using a prospective, single-blind, randomized, placebo controlled design we evaluated the effect of laser acupuncture on bladder reservoir function and enuresis frequency in cases of monosymptomatic nocturnal enuresis with reduced maximal voided volume. A total of 31 patients with monosymptomatic nocturnal enuresis, with at least 3 enuretic nights per week and less than 70% of normal age related maximal voided volume without first morning void (Koff's formula), no constipation, urinary tract abnormalities, or daytime incontinence were randomized into group 1--active laser acupuncture, group 2--placebo treatment with red light and skin contact and group 3--placebo treatment with red light without skin contact. After a 2-week run-in period (when patients made home recordings of nocturnal urinary production and during 2 weekends frequency-volume charts), the patients started a 5-week treatment. During the last 2 weeks of treatment patients performed the same recordings as during the run-in period. We found no significant effect of active laser acupuncture on maximal voided volume (first morning void excluded), maximal morning voided volume, voiding frequency, enuresis frequency before and after treatment or nocturnal urine production among the patient groups. However, we found that laser acupuncture resulted in a significant increase in average daytime voided volume. We found no effect of skin contact during placebo laser acupuncture. Laser acupuncture is a safe but inefficient treatment for monosymptomatic nocturnal enuresis with reduced maximal voided volume. However, we found subtle effects on bladder reservoir function.

1733 GROUPING OF NOCTURIA BASED ON BLADDER CAPACITY AND NOCTURNAL POLYURIA AND ITS ASSOCIATION WITH LOWER URINARY TRACT SYMPTOMS AND SLEEP DISORDER IN MEN WITH NOCTURIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History/Evaluation and Markers1 Apr 20111733 GROUPING OF NOCTURIA BASED ON BLADDER CAPACITY AND NOCTURNAL POLYURIA AND ITS ASSOCIATION WITH LOWER URINARY TRACT SYMPTOMS AND SLEEP DISORDER IN MEN WITH NOCTURIA Tetsuya Fujimura, Haruki Kume, Taro Murata, Masayoshi Nagata, Motofumi Suzuki, Hiroshi Fukuhara, Yutaka Enomoto, Hiroaki Nishimatsu, Yasuhiko Igawa, and Yukio Homma Tetsuya FujimuraTetsuya Fujimura Tokyo, Japan More articles by this author , Haruki KumeHaruki Kume Tokyo, Japan More articles by this author , Taro MurataTaro Murata Tokyo, Japan More articles by this author , Masayoshi NagataMasayoshi Nagata Tokyo, Japan More articles by this author , Motofumi SuzukiMotofumi Suzuki Tokyo, Japan More articles by this author , Hiroshi FukuharaHiroshi Fukuhara Tokyo, Japan More articles by this author , Yutaka EnomotoYutaka Enomoto Tokyo, Japan More articles by this author , Hiroaki NishimatsuHiroaki Nishimatsu Tokyo, Japan More articles by this author , Yasuhiko IgawaYasuhiko Igawa Tokyo, Japan More articles by this author , and Yukio HommaYukio Homma Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2004AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nocturia (waking at night 1 or more times to void) is a common cause of awakenings and may lead to sleep disturbance. Nocturia is a multifocal condition with many possible contributing etiological factors. However, precise etiology in each individual is deceptively difficult. The aim of study is to examine the correlations among frequency volume chart (FVC) data and basic characteristics including symptom profiles assessed by Core Lower urinary tract Symptom Score (CLSS)(Int J Urol. 15: 816)and Athens Insomnia Scale (AIS) in men with nocturia. METHODS Consecutive 131 men with nocturia (once or more) completed self-reported questionnaires (CLSS and AIS) and FVC for two days. They were divided into four groups: group 1; no reduced bladder capacity (RC) and no nocturnal polyuria (NP), group 2; no RC and NP, group 3; RC and no NP, and group 4; RC and NP. RC indicated a maximum voided volume less than 4 ml/body weight. NP was defined as nocturnal urine output larger than 33 % of one-day output or10 ml/body weight (J Urol. 163: 777). Clinical characteristics (age, PSA, uroflowmetry, and questionnaire scores) were compared among groups. RESULTS Men were classified as group 1 (15.3%), group 2 (49.6%), group 3 (13.7%), and group 4 (21.4%). More than 70% of men had NP (groups 2 and 4). Group 1 men (no RC and no NP) had significant poorer sleep, such as awakening during the night and final awakening. When men with nocturia≥ 3 times alone were compared, men of group 1 significantly more often complained of bladder pain or urethral pain, and men of group 2 were significantly bothered by urgency and straining. CONCLUSIONS These observations indicate multi-factorial backgrounds for nocturia in men, suggesting variable predominance of sleep disorders, bladder hypersensitivity and voiding difficulty among the four groups. Our classification of nocturia may be useful for the assessment and treatment choice of men with nocturia. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e696 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tetsuya Fujimura Tokyo, Japan More articles by this author Haruki Kume Tokyo, Japan More articles by this author Taro Murata Tokyo, Japan More articles by this author Masayoshi Nagata Tokyo, Japan More articles by this author Motofumi Suzuki Tokyo, Japan More articles by this author Hiroshi Fukuhara Tokyo, Japan More articles by this author Yutaka Enomoto Tokyo, Japan More articles by this author Hiroaki Nishimatsu Tokyo, Japan More articles by this author Yasuhiko Igawa Tokyo, Japan More articles by this author Yukio Homma Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Short Term Effect and Safety of Antidiuretic Hormone in the Patients with Nocturia

PurposeTo investigate the short-term safety of antidiuretic hormone in elderly patients with nocturnal polyuria, focus on hyponatremia and others electrolytes disturbances and to assess short-term effects on nocturnal urine output and number of nocturnal voids.MethodsBetween June 2005 and August 2006, a total of 34 patients with nocturnal polyuria were orally administered 0.2 mg desmopressin tablet at bedtime for two weeks. Serum sodium, others electrolytes, urine sodium and urine osmolarity were assessed in the third days, one week and two weeks after treatment with desmopressin and compared adult group (<65 years of age) with elderly group (≥65 years of age). We assessed the effect of desmopressin using a frequency-volume charts and analysed.ResultsIn total 34 patients (20 adult, 14 elderly) were analyzed. Desmopressin treatment did not significantly change serum and urine electrolytes include soduim concentration in elderly patients comparied with adult patients. Serum sodium concentration below normal range was recorded in 2 patients in elderly group, but no serious adverse events occurred and recovered without sequelae. The mean number of nocturnal voids decresed (54% reduction) and nocturnal urine output decreased (57% reduction) after using desmopressin.ConclusionsDesmopressin was well tolerated and effective in elderly patients with nocturnal polyuria without clinically significant hyponatremia.

Low Dose Oral Desmopressin for Nocturnal Polyuria in Patients With Benign Prostatic Hyperplasia: A Double-Blind, Placebo Controlled, Randomized Study

We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30% of total daily urine volume. Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia, nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study. All patients received placebo or 0.1 mg desmopressin orally at bedtime. Patients were required to visit the outpatient clinic from the first visit, and after 1, 3, 6 and 12 months of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. During followup urinalysis, urine sodium, urine osmolality, serum electrolytes, prostate specific antigen, International Prostate Symptom Score, quality of life, transrectal ultrasonography of prostate, uroflowmetry and post-void residual urine volume were performed at each visit. A total of 115 patients were enrolled in the study and randomized as 58 in the placebo group and 57 in the desmopressin group. Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes, and prolonged the first sleep period (p < 0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 12 months of treatment. No serious systemic complications were found during medication. Low dose oral desmopressin is an effective and well tolerated treatment for nocturnal polyuria in the lower urinary tract symptoms of patients with benign prostatic hyperplasia. Long-term desmopressin therapy gradually decreases serum sodium and it might induce hyponatremia even in patients without initial hyponatremia. For long-term desmopressin administration serum sodium should be assessed carefully, at least at 1 week after treatment.

Abnormal Diurnal Rhythm of Urine Output Following Renal Transplantation: The Impact of Blood Pressure and Diuretics

Background Nocturnal polyuria is the excretion at night of an excessive volume of urine. A major problem following renal transplantion is an abnormal diurnal rhythmicity in urine output. The purpose of this study was to elucidate the prevalence of nocturnal polyuria among renal transplant recipients in the early period after transplantation as well as at least 1 year after transplantation. We aimed to explore possible pathophysiological mechanisms behind nocturnal polyuria in this group of patients, focusing on the impact of blood pressure and medication. Methods Seventeen recently transplanted patients 17 late transplant recipients, and 17 healthy controls were included in the study. Voiding habits were assessed by completion of a frequency-volume chart recording all fluid intakes and voiding. A concomitant 24-hour blood pressure profile was obtained in all. Results Renal transplant recipients had a high prevalence of nocturnal polyuria (74%) and a disturbed blood pressure profile with a lack of appropriate nocturnal dipping ( P < .0001) compared to controls. We found a positive correlation between increased nocturnal blood pressure and urine output at night ( r = .368, P = .008). Patients taking diuretics had a circadian diurnal rhythm of urine output and a blood pressure profile similar to controls. Conclusions Nocturnal polyuria was very common among both recent and late transplant recipients. A high fluid intake during daytime and hypervolemia were suggested as causes of a disturbed blood pressure profile, which partly seemed to explain the high urine output at night. Daytime diuretics may be an effective treatment of this inconvenient complication.

Prospective Evaluation of Factors Affecting the Response and Relapse Rates to Desmopressin Therapy in Monosymptomatic Enuretic Postadolescent Males

Purpose To investigate the factors affecting desmopressin response and relapse rates in an postadolescent male population with monosymptomatic nocturnal enuresis (MNE). Material and Methods Between September 2007 and January 2009, a total of 143 male soldiers with nocturnal enuresis admitted to a military referral center. Eighty-six male soldiers with MNE were investigated. Family history, smoking habits, previous treatment history, coexisting urinary symptoms, bowel habits, maximal functional bladder capacity, and body mass index were examined to determine their effects on desmopressin response. All patients initially received 0.2 mg of desmopressin. Patients were evaluated after 2 weeks and non-full responders were switched to 0.4-mg desmopressin, with total treatment duration of 3 months. Results Of the 86 patients with MNE, 37 patients (43%) showed full response. None of the investigated parameters were shown to affect response rates. With regard to the relapse rates, 36.1% of the patients were taking 0.2-mg tablets and 63.9% were taking 0.4-mg tablets. This difference was statistically significant (P Conclusions Postadolescent male MNE is a heterogeneous condition and desmopressin appears to be an effective and well-tolerated treatment. Higher response rate can be predicted if the nocturnal urine output exceeds functional bladder capacity for each individual. Our study also contributed that relapse rates depend on initial tailored dose; however, this needs to be confirmed with further studies.

Increased Nocturnal Blood Pressure in Enuretic Children With Polyuria

We investigated the association between nocturnal blood pressure and urine production in children with enuresis. A total of 39 consecutive children with a mean age of 9.8 years (range 6.2 to 14.9) with monosymptomatic nocturnal enuresis completed a bladder diary, including 2 weeks of basic documentation and 2 with desmopressin titration from 120 to 240 microg sublingually. Arterial blood pressure was measured every 30 minutes during 24 hours and during 4 additional nights using an ambulatory blood pressure monitor. Furthermore, 10 healthy children were recruited into the study who completed a bladder diary for 5 days while measuring arterial blood pressures with documentation of all intake and voided volumes. Patients with nocturnal polyuria had significantly higher nocturnal mean arterial pressure than patients without polyuria and controls (p <0.05). Furthermore, a positive correlation was seen between nocturnal urine output and nocturnal mean arterial pressure (r = 0.32, p <0.001). Nocturnal urine output was significantly higher during wet nights than dry nights (p <0.001). However, no significant difference was found in mean arterial pressure between wet and dry nights. Nocturnal mean arterial pressure was significantly higher in children with enuresis with polyuria than in children without polyuria. There was a significant positive correlation between average nocturnal mean arterial pressure and nocturnal urine volume in the whole study. The association between nocturnal blood pressure and urine volume, and the role of blood pressure should be investigated in a larger group of children with enuresis who have nocturnal polyuria.

Prospective Evaluation of Factors Affecting the Response and Relapse Rates to Desmopressin Therapy in Male Monosymptomatic Enuretic Adults

To investigate the factors affecting desmopressin response and relapse rates in an adult male population with monosymptomatic nocturnal enuresis (MNE). Nocturnal enuresis is a frequent heterogeneous condition, which is genetically complex in nature. Between September 2007 and January 2009, a total of 143 male soldiers with nocturnal enuresis admitted to a military referral center. Eighty-six male soldiers with MNE were investigated. Family history, smoking habits, previous treatment history, coexisting urinary symptoms, bowel habits, maximal functional bladder capacity, and body mass index were examined to determine their effects on desmopressin response. All patients initially received 0.2 mg of desmopressin. Patients were evaluated after 2 weeks and non-full responders were switched to 0.4-mg desmopressin, with total treatment duration of 3 months. The mean follow-up after starting the initial dose was 9.4 months (4.5-15 months). Of the 86 patients with MNE, 37 patients (43%) showed full response. None of the investigated parameters were shown to affect response rates. With regard to the relapse rates, 36.1% of the patients were taking 0.2-mg tablets and 63.9% were taking 0.4-mg tablets. This difference was statistically significant (P <.05). Other parameters did not have any significant effect on relapse rates. Adult male MNE is a heterogeneous condition and desmopressin appears to be an effective and well-tolerated treatment. Higher response rate can be predicted if the nocturnal urine output exceeds functional bladder capacity for each individual. Our study also contributed that relapse rates depend on initial tailored dose; however, this needs to be confirmed with further studies.

The effect of familial aggregation on the children with primary nocturnal enuresis

To evaluate the effect of familial aggregation on the children with PNE by evaluating nocturnal urine output, bladder, and arouse function. According to whether relatives of family of probands over three generations were affected by PNE, forty-five children with familial aggregation PNE (FPNE), seventy children with sporadic PNE (SPNE) and ten children with normal lower urinary tract function but waiting for operation (control group) were included. Questionnaire of arousal from sleep (AS scores), bladder diary and daytime urodynamic studies were performed in all patients. The incidences of severe PNE and nonmonosymptomatic PNE in FPNE group were significantly higher than those in SPNE group. The nocturnal urine output and AS scores in both PNE groups was significantly higher, maximal voided volume significantly smaller than those in control group. Moreover, the incidences of small bladder in FPNE group was 44%, significantly higher than that in SPNE group (21%), but no significantly difference was found in nocturnal polyuria and arousal AS scores between two PNE groups. There were 53% patents with daytime detrusor overactivity and 60% patents with urodynamic functional bladder outflow obstruction in FPNE group, significantly higher than those in SPNE group (19% and 37%). Maximum cystometric capacity significantly decreased from control group to FPNE group. Familial aggregation has significant effects on the children with PNE, and FPNE are more likely to be severe symptoms and bladder dysfunction. It would be beneficial to have an urodynamic study for their diagnosis and treatment. Neurourol. Urodynam. 28:423-426, 2009. (c) 2008 Wiley-Liss, Inc.