Nocturnal Voids Research Articles

70 - From nocturnal awakenings to nocturnal voiding: the relationship between insomnia and nocturia. A systematic review.

70 - From nocturnal awakenings to nocturnal voiding: the relationship between insomnia and nocturia. A systematic review.

Urothelial Piezo1 channels do not alter voiding or afferent nerve sensitivity in the mouse

The mechanosensitive piezo ion channels, Piezo1 and Piezo2, are expressed in tissues of the lower urinary tract, including the urothelium and sensory nerves. Interest in a role of piezo mechanosensitive ion channels in mediating sensory physiology in the lower urinary tract has been highlighted by the recent reports of putative voiding dysfunction in mice lacking Piezo2 channels in the lower extremities and sensory nerves (Marshall et al 2020) and Piezo1/2 in urothelium (Dalghi et al 2022). To investigate the potential role of urothelial Piezo1 channels in mediating normal function in the lower urinary tract, we generated a mouse line in which the Piezo1 gene can be conditionally knocked out in the urothelium (Piezo1UPKcKO mice). We examined spontaneous voiding behavior in male and female Piezo1UPKcKO and control mice during the light and dark phases of the day/night cycle. There were no gender differences in voiding parameters in our study (p=0.659, 3-way ANOVA), thus we did not isolate gender as a variable for further analysis. Piezo1UPKcKO mice (n=9) voided 6 ± 1 times per 24 hours, while the control mice (n=11) voided 7 ± 1 times per 24 hours (p = 0.7281). A clear nocturnal voiding pattern was observed with both Piezo1UPKcKO and control mice exhibiting more frequent voids during the dark cycle, but there were no differences in the number of voids, intermicturition intervals, or void volumes in any cycle between Piezo1UPKcKO and control mice. These results indicate that spontaneous voiding behavior remains fully intact in both male and female Piezo1UPKcKO mice during the light and dark phases of the day/night cycle. Furthermore, in an ex vivo bladder model where we measure afferent nerve output from the bladder during filling cycles, sensory nerve activity in the Piezo1UPKcKO mice was similar to that in bladders from control animals. The maximum frequency of afferent nerve activity during bladder filling reached 295 ± 28 Hz in control mice (n=6) and 336 ± 34 Hz in Piezo1UPKcKO mice (n=6; p = 0.368). Functional Piezo1 activity could be demonstrated in bladders from both Piezo1UPKcKO and control mice, as the pharmacological activator for Piezo1 channels, Yoda1 (5 μM) increased maximum afferent nerve activity during bladder filling by 60 ± 15 Hz in control mice (P = 0.0029) and 33 ± 15 Hz in Piezo1UPKcKO mice (P = 0.0567). In Ca2+ imaging experiments, we found that Yoda1 induced an increase in Ca2+ signaling events in urothelial tissue from control mice. Thus, it appears that urothelial cells express functional Piezo1 ion channels, but activity of these channels is not required for maintaining normal sensory nerve activity and voiding behavior. This work was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK125543). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Efficacy and predictive factors of clinical response to hyaluronic acid ＋ chondroitin sulfate bladder instillations for the treatment of BPS/IC

Aim of the study:To assess the efficacy of intravesical hyaluronic acid and chondroitin sulfate (HACS) instillations in treating patients with bladder pain syndrome/interstitial cystitis (BPS/IC), as well as to identify predictive factors for clinical response. Materials and methods:Patients diagnosed with BPS/IC and treated with Ialuril® (HACS) bladder instillations between January 2018 and August 2020 were included. Data collected included Visual Analog Scale (VAS) scores, number of pain episodes, 3-day frequency volume chart measurements (at baseline and last follow-up), Patient Global Impression of Improvement (PGI-I) questionnaire responses, age, history of urinary tract infections (UTIs), and endoscopic findings from cystoscopy with hydrodistension. Statistical analyses included Mann–Whitney’s non-parametric U-test and chi-square test with a 95% confidence interval (p ≤ 0.05) to identify predictive factors of treatment success. Results:A total of 104 patients were treated with a median follow-up of 29 months (IQR 14–40), predominantly female with a mean age of 60 ± 16 years. At the last follow-up, there was a median reduction of 1 point in the VAS score (IQR 1–1), whilst only 20% experienced a reduction of ≥2 points. A statistically significant correlation was observed in the reduction of days with pain per month before and after treatment (ΔDPV) (median reduction: 6 days, IQR 2–7, p < 0.001). No adverse events were reported during treatment. Regarding prognostic factors, three statistically significant correlations were found: between PGI-I success and age (p=0.050), between ΔVAS score and recurrent UTIs (p=0.044), and between ΔDPV and recurrent UTIs (p=0.04). Discussion:The study did not demonstrate any significant reduction of VAS score or diurnal and nocturnal voiding frequency after treatment, on the contrary it did show a reduction in the number of days with pain. Consequently, 88.3% of patients reported positive subjective improvement on the PGI-I questionnaire, and none discontinued treatment. Endoscopic findings did not appear to correlate with treatment response. Conclusions:Age and the presence of recurrent UTIs may influence the response to intravesical HACS therapy in terms of PGI-I, VAS score, and reduction in days with pain.

Prevalence of Sleep CALM nocturia factors in a male veteran population.

Nocturia is a complex and multifactorial condition, associated with several genitourinary abnormalities as well as a host of conditions beyond the urinary tract, and thus often poses a significant diagnostic challenge in real-world practice. Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications, the so-called "Sleep C.A.L.M." factors, are five common causes of nocturia requiring judicious evaluation according to current consensus guidelines. This study aims to assess the prevalence of the Sleep C.A.L.M. factors in a nocturia clinical population. Retrospective analysis of frequency-volume charts from men with ≥2 nocturnal voids as well as concurrent demographic, clinical, and medical history data to identify patients with each of the Sleep C.A.L.M. Comorbidities and medications were classified as a single group. A total of 213 subjects met the criteria for inclusion (median age 68.0 [63.5-75.5] years). The prevalence of 1) sleep disorders, 2) comorbidities and/or medication use, 3) actions (i.e., modifiable behaviors/lifestyle factors), and 4) lower urinary tract dysfunction was 31%, 31%, 19%, and 41%, respectively. Among included participants, 73% were found to have at least 1 Sleep C.A.L.M. factor, and 33% had multiple Sleep C.A.L.M. Results were similar upon stratification by age and nocturnal polyuria status. The Sleep C.A.L.M. factors are highly common among nocturia patients in the clinical urology setting. Although many of these factors are strongly associated with advanced age in community-based nocturia study samples, they appear common even among younger men in a nocturia patient population; the differential effect of age and individual Sleep C.A.L.M. factors on nocturia pathophysiology requires further investigation.

Prevalência de noctúria e fatores associados em mulheres atendidas em dois ambulatórios de uroginecologia no estado do Rio de Janeiro: um estudo transversal

Abstract Objective To identify the prevalence and factors related to nocturia in women presenting lower urinary tract symptoms. Methods Observational cross-sectional survey, individualized, hospital-based, involving women attended by the Unified Health System in urogynecology outpatient clinics in Niterói and Petrópolis, RJ, Brazil. Sociodemographic, clinical, and lifestyle data were collected. Two outcomes of nocturia were considered: one or more nocturnal voids and two or more nocturnal voids, the latter due to its greater impact on quality of life. Associations between the investigated variables and the outcomes were assessed by logistic regression models, and crude and adjusted odds ratios were obtained. Results A total of 132 participants were included. The prevalence of nocturia was 71.2%, and of two or more voids, 56.8%. Lower education level OR 0,260 (0,106; 0,637), mixed urinary incontinence OR 2,533 (1,103; 5,817), and three or more comorbidities OR 3,105 (1,340; 7,196) were associated with a higher chance of nocturia. Lower education level OR 0,324 (0,148; 0,709), lower caffeine consumption OR 0,995 (0,990; 1,000), and overactive bladder syndrome OR 2,761 (1,189; 6,409) were associated with a higher chance of two or more voids. Conclusions In the population attending specialized services, the prevalence of nocturia was similar to that of the general population and to that of similar services, but the prevalence of two or more voids was higher. Active screening for nocturia in women with comorbidities, especially three or more, and their adequate management, proved to be important in addressing the symptom.

Association between nocturia and serum albumin in the U.S. adults from NHANES 2005-2012.

Nocturia, a prevalent chronic condition, impacts individuals' quality of life but remains underexplored. This study aimed to assess the association between serum albumin levels and nocturia. Based on the analysis of the National Health and Nutrition Examination Survey (NHANES) database (2005-2012), our study included a total of 6345 adults (≥20 years old). Nocturia was defined as ≥2 nocturnal voiding episodes. Logistic regression and smooth curve fitting analyzed the linear and nonlinear correlations between serum albumin and nocturia, with subgroup analysis. Among 6345 participants, 1821 (28.7%) experienced nocturia. Logistic regression analysis revealed a linear negative correlation between serum albumin and nocturia risk (OR = 0.9549, 95% CI = 0.9280 ~ 0.9827, P = 0.002). Even after quartile division of serum albumin concentration, this correlation persisted within each group, and a smooth curve fitting validated the nonlinear negative correlation between the two. Subgroup analysis further demonstrated significant impacts of body mass index (BMI), alcohol consumption, and age on this association. This cross-sectional study indicated that higher serum albumin levels were associated with a reduced risk of nocturia in U.S. adults aged 20 and older, highlighting the importance of serum albumin in the prevention and treatment of nocturia and providing clinical guidance.

Association of nocturia with cardiovascular and all-cause mortality: a prospective cohort study with up to 31 years of follow-up.

Nocturia is a highly prevalent and under-considered condition and impacts the quality of life for many individuals. The long-term impact of nocturnal voiding on mortality, especially mortality from cardiovascular disease, remains unknown. The current study aimed to evaluate the relationship of nocturnal voiding episodes with cardiovascular and all-cause mortality among adults in the United States. This is a prospective cohort study of a nationally representative sample of 13,862 U.S. adults aged 20 years or older who participated in the National Health and Nutrition Examination Survey III (1988-1994). Nighttime urination frequency was reported during an in-house interview. All-cause and cause-specific mortality were ascertained by linking to National Death Index mortality data through December 31, 2019. The associations of nocturia with cardiovascular and all-cause mortality were estimated using weighted Cox proportional hazards regression models. Throughout a median follow-up of 26.7 years, 5,029 deaths were reported, comprising 1,720 deaths from cardiovascular disease. In the fully adjusted model, participants who reported once, twice, and three or more times nocturnal voiding episodes have a higher risk of cardiovascular mortality (HR1, 1.22 [95% CI, 0.997-1.49], HR2, 1.47 [95% CI, 1.13-1.91], and HR ≥ 3, 1.96 [95% CI, 1.52-2.53]) as well as all-cause mortality (HR1, 1.12 [95% CI, 0.90-1.39], HR2, 1.54 [95% CI, 1.23-1.93], and HR ≥ 3, 2.48 [95% CI, 1.81-3.40]), compared to those without nocturia, and heart disease-specific mortality (HR1, 1.33 [95% CI, 1.08-1.64], HR2, 1.62 [95% CI, 1.25-2.10], and HR≥3, 2.07 [95% CI, 1.61-2.67]). Nevertheless, there was no significant relationship between the number of nocturia episode changes and stroke-specific mortality. Nocturia was associated with a significantly augmented risk of overall and heart disease-specific mortality in a dosage-dependent manner. Early recognition and taking precautions may benefit individuals with nocturia by promoting quality of life and cardiac health.

From nocturnal awakenings to nocturnal voiding: the relationship between insomnia and nocturia - a systematic review.

The aim of this study was to systematically evaluate relevant literature regarding 1) the prevalence of nocturia in patients with insomnia; 2) sleep characteristics of insomniacs with and without nocturia; 3) interventions for the treatment of insomnia and their effect on nocturia. A systematic review of literature was performed through EMBASE, MEDLINE, CLINICALTRIALS.GOV and CENTRAL databases up until November 2022 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. From the identified reports, 11 studies were retained, of which 7 were eligible for meta-analysis. Bias assessment was performed using the ROBINS tools as per the Cochrane collaboration guidelines. A total of 5396 older adults were included in the meta-analysis. The pooled estimate of the OR was 1.958 (95% CI: 1.609-2.384) for nocturia in patients with insomnia based on 7 studies in a random effects model with nonsignificant heterogeneity (I2=50.83%, P=0.06). Wake after sleep onset (WASO) was longer in people with insomnia and nocturia compared to those without and sleep efficiency (SE) declined. Interventions with melatonin, diet and behavioral therapy were beneficial on nocturia frequency in insomniacs. A limiting factor of our analysis was the scarcity of available data, potentially causing an important selection bias. The overall odds for nocturia in older adults is higher in patients with insomnia than those without and is associated with worse sleep outcomes. Interventions for treating insomnia such as melatonin, behavioral therapy and diet show beneficial results on nocturnal voiding frequency. We advocate for further research in which uniform definitions and questionnaires are used. Routine screening for nocturia in patients with insomnia could be beneficial to maximize sleep quality improvement.

Association of nocturia of self-report with estimated glomerular filtration rate: a cross-sectional study from the NHANES 2005–2018

Nocturia is a manifestation of systemic diseases, in which chronic kidney disease (CKD) is an independent predictor of nocturia due to its osmotic diuretic mechanism. However, to our knowledge, previous studies have not examined the association between nocturia and estimated glomerular filtration rate (eGFR). The purpose of this study was to assess the association between nocturia exposure and eGFR in the general US population. This study presents a cross-sectional analysis of the general US population enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. To account for potential confounding factors, linear regression analysis was conducted to investigate the association between nocturia and eGFR. Stratified analyses and interaction tests were employed to examine the variables of interest. Additionally, sensitivity analyses were conducted across diverse populations. A total of 12,265 individuals were included in the study. After controlling for confounding factors, the results of the linear regression analysis indicated that a single increase in nocturnal voiding frequency was associated with a decrease in eGFR by 2.0 mL/min/1.73 m2. In comparison to individuals with a nocturnal urinary frequency of 0, those who voided 1, 2, 3, 4, and ≥ 5 times at night experienced a decrease in eGFR by 3.1, 5.4, 6.4, 8.6 and 4.0 mL/min/1.73 m2, respectively. Nocturia was found to be associated with a decreased eGFR of 4 mL/min/1.73 m2 when compared to individuals without nocturia. The sensitivity analysis yielded consistent findings regarding the association between nocturia and eGFR in both CKD and non-CKD populations, as well as in hypertensive and non-hypertensive populations. Nevertheless, inconsistent conclusions were observed across various prognostic risk populations within the CKD context. The presence of nocturia and heightened frequency of nocturnal urination have been found to be associated with a decline in eGFR.

Association Between Before-bedtime Passive Body Heating and Nocturia During the Cold Season Among Older Adults.

Cold exposure induces lower urinary tract symptoms, including nocturia. Cold-induced detrusor overactivity can be alleviated by increasing skin temperature in rats. However, no study has shown an association between passive heating via hot-water bathing and nocturia among humans. We included 1,051 Japanese community-dwelling older adults (mean age: 71.7 years) in this cross-sectional study from 2010 to 2014. The number of nocturnal voids was recorded in a self-administered urination diary. Nocturia was defined as ≥2 nocturnal voids. We evaluated bathing conditions in the participants' houses. Hot-water bathing (n = 888) was associated with a lower prevalence of nocturia than no bathing (n = 163), independent of potential confounders, including age, sex, obesity, income, physical activity, diabetes, medication (diuretics, nondiuretic antihypertensives, and hypnotics), depressive symptoms, indoor/outdoor temperature, and day length (odds ratio [OR] 0.68; 95% confidence interval [CI], 0.48-0.97; P = 0.035). Compared with the quartile group with the longest bath-to-bed interval (range: 161-576 min), the second and third quartile groups (range: 61-100 and 101-160 min, respectively) were associated with a lower prevalence of nocturia, after adjusting for water temperature and bathing duration besides the same covariates (OR 0.60; 95% CI, 0.38-0.96; P = 0.031 and OR 0.59; 95% CI, 0.37-0.94; P = 0.025, respectively). Hot-water bathing, particularly with a bath-to-bed interval of 61-160 min, was significantly associated with a lower prevalence of nocturia among older adults.

0384 Assessing the content validity of the IDSIQ through cognitive interviews in individuals with comorbid insomnia and nocturia

Abstract Introduction The Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ) is validated to measure daytime functioning in individuals with insomnia disorder. This study assessed the content validity of the IDSIQ through cognitive interviews in individuals with insomnia and comorbid nocturia. Methods This was a cross-sectional, qualitative observational study. Data were collected from 10 adult subjects from the US suffering from insomnia disorder (DSM-5) and comorbid nocturia (≥2 nocturnal voids). One-on-one, web-based interviews were conducted using semi-structured guides and lasted 60–90 minutes. Based on the stage of the study, all participants examined the content validity of the IDSIQ as part of 1) hybrid concept elicitation and cognitive interviews (n=5; Stage 1), or 2) cognitive interviews (n=5; Stage 2). Institutional review board approval and web-based informed consent were obtained prior to the patient interviews. Results The mean age of participants was 59.5 years (SD=4.3) and 62.2 years (SD=8.5) in the hybrid and cognitive interview groups, respectively. All individuals in the hybrid interviews were female, whereas all individuals in the cognitive interviews were male. Participants’ overall impressions were positive (10/10), describing the IDSIQ as straightforward (5/10), good (1/10), simple (1/10), very precise (1/10), very specific (1/10), clear (1/10), and aligned with their experience (3/10). The items were understood by all participants (10/10) except Item 1, which was understood by almost all participants (9/10). One participant suggested that the responses to questions on the IDSIQ may vary depending on the time the survey is administered, and the amount of sleep obtained the previous night. All 10 participants reported that they could answer all questions. Of the nine participants who were asked, all stated that the IDSIQ was relevant to their experience of their condition. Most participants reported that there were no missing items, whereas two participants stated that an item assessing the impact of insomnia on personal relationships (including family) was missing. Conclusion The content of the IDSIQ was easy to understand by patients that suffer from insomnia and comorbid nocturia. The study provides evidence for the content validity of the IDSIQ and its applicability in this population. Support (if any) Funded by Idorsia Pharmaceuticals Ltd.

0406 Impact of comorbid insomnia and nocturia on subjects' lives as assessed through a concept elicitation study

Abstract Introduction The lived experiences of individuals with insomnia and comorbid nocturia are not properly understood. This study explored the lived experiences of individuals with insomnia and comorbid nocturia to identify relevant concepts that could be reflected in patient-reported outcome (PRO) endpoints in clinical studies. Methods This was a cross-sectional, qualitative observational study. Data were collected from a sample of 10 adult subjects from the US suffering from insomnia disorder (DSM-5) and comorbid nocturia (≥2 nocturnal voids). Interviews were conducted using semi-structured guides, lasted 60–90 minutes, and assessed patient-relevant concepts of interest for their insomnia and nocturia. Institutional review board approval and web-based informed consent were obtained prior to the interviews. Results Overall, 10 participants were included, and the mean age was 61 years (SD=6). Most participants were female (8/10), White (9/10), and lived with a partner/spouse, family, or friends (8/10). Almost all participants experienced insomnia symptoms at least 5 nights per week (9/10), most often impacting their emotional (10/10), social (10/10), physical (9/10), cognitive (9/10), and work and productivity (6/10) functioning. Almost all participants reported that decreasing the impact of insomnia would be meaningful (8/10), most often mentioning improvements in physical impacts such as having more energy or feeling less exhausted (7/10). All participants experienced nocturia at least 6 nights per week (10/10), often impacting their emotional (7/10), social (6/10), physical (6/10), cognitive (4/10), and work and productivity (4/10) functioning. Participants reported that going to the bathroom less often (i.e., two times per night, once per night, or not at all; each 2/10) and being able to sleep through the night (2/10) would be meaningful improvements. Conclusion Individuals with insomnia and nocturia experience disrupted sleep patterns that impact their emotional, social, physical, cognitive, and work functioning. Feeling less tired, being able to sleep through the night, and getting up less often to use the bathroom would be meaningful to patients living with both conditions. Support (if any) Funded by Idorsia Pharmaceuticals Ltd.

Did nocturia, in hypertension, correlate with dipping status?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The association between nocturia and hypertension has been widely reported yet remains poorly characterized, precluding a more refined understanding of blood pressure as it relates to the cardiovascular setting. Nocturia is associated with significant morbidity and mortality (1,2,3) which is thought to be mediated in large part by the fact that nocturia is a potential manifestation of systemic disease (4). Previous studies have reported that heart failure and uncontrolled hypertension were responsible for clinically significant nocturia (5,6). However, it remains unclear the relationship with any hypertension mechanism and the effect on circadian blood pressure rhythm. Purpose To investigate characteristics of hypertensive patients in who complain for nocturia. Methods We prospectively recruit 49 patients among outpatients attending the Hypertension Centre of Hospital San Luca, Istituto Auxologico Italiano. Physical examination, standard routine blood tests, urine analysis for microalbuminuria, 24-hour sodium excretion, 24-hour urinary cortisol levels, 24-hour urinary metanephrine/normetanephrine and a standard 24h ABPM has been performed. We asses in every patients the presence of nocturia (≥2 nightly voids) then we compare sub mentioned features between patients with nocturia or not. Results The population recruited demonstrate a mean age of 62 years old, it is made by a majority of men (M 61%, F 39%). We found nocturia in 13 patients on the 49 recruited. Demographic, anthropometrical and hematochemical features of the population recruited is described in Table 1. We compare patients who complain nocturia with patients with a normal number of nocturnal voids. Only height and hemoglobin demonstrate significative difference in the population. In a second analysis we compare ABPM results of patients with nocturia with patients who don’t have this symptom. The results are described in Table 2. Differently to what we expect no difference is demonstrated between the two group in dipping status, we found a significative difference in overall heart rate, this difference is evident only the day period but not in the night period. Conclusion These preliminary data suggest that patients with nocturia than patient with normal number of nocturnal voids i) have lower height and hemoglobin level, this in support to nocturia is a potential manifestation of systemic disease (4);) have both a lower overall and diurnal cardiac frequency. No dipping correlation have been found in our study, more study are needed to clarify a potential relationship with sleep disorder.

THE IMPACT OF NOCTURIA ON MORTALITY : A SYSTEMATIC REVIEW

The International Classification of Sleep Disorders (ICS) describes nocturia as "voiding that occurs during the main sleep period". However, there are some medical specialists who do not believe that feeling one emptiness while sleeping qualifies as a clinically important occurrence. They believe that this viewpoint is supported by the evidence. This might be owing to the fact that some studies have indicated that having fewer than two voids every night is not an issue, whilst other studies have found that having more than two voids every night can reduce quality of life. Having fewer than two voids every night is not a problem. Having more than two voids every night is a problem. The most common and bothersome symptom related to urination is called nocturia. 10 million people in the United States suffer with nocturia, yet only 1.5 million get treated for it. This annoys seventy percent of individuals over the age of thirty who get up at least twice throughout the night to use the toilet. People who suffer from the illness known as nocturnal enuresis are characterized by their inability to recognize when they have a full bladder and their involuntary need to empty while sleeping. Nocturia is quite similar to nocturnal frequency, with the exception that sleep comes before and after episodes of urination. Even though voiding diaries call it nocturia, getting up in the middle of the night for any reason other than to urinate is not considered to be nocturia. Convenience void. Nocturia is frequently caused by overactive bladders rather than illnesses of the urinary system. Patients who experienced urine urgency in the afternoon were also likely to have nocturia. Mortality is increased in patients with nocturia who have three or more nocturnal voids per night. The condition known as nocturia has been linked to an increased risk of death. Those who have had nocturia more than three times are at an increased risk of mortality.

MP03-09 PHENOTYPING NOCTURIA IN HYPERTENSIVES ACCORDING TO 24-HOUR URINE COMPOSITION

You have accessJournal of UrologyCME1 Apr 2023MP03-09 PHENOTYPING NOCTURIA IN HYPERTENSIVES ACCORDING TO 24-HOUR URINE COMPOSITION Joseph Boroda, Susan Gong, Frederick Okoye, Syed Rahman, Matthew Moy, Alla Akivis, Jason Lazar, and Jeffrey Weiss Joseph BorodaJoseph Boroda More articles by this author , Susan GongSusan Gong More articles by this author , Frederick OkoyeFrederick Okoye More articles by this author , Syed RahmanSyed Rahman More articles by this author , Matthew MoyMatthew Moy More articles by this author , Alla AkivisAlla Akivis More articles by this author , Jason LazarJason Lazar More articles by this author , and Jeffrey WeissJeffrey Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are numerous comorbidities correlated with nocturia, among the most clinically significant of these being hypertension. Elevation in blood pressure (BP) suppresses serum arginine vasopressin levels, lending evidence to the idea that hypertension is associated pathophysiologically with nocturnal polyuria, which may cause nocturia. Greater nighttime BP and lower nocturnal BP dipping have been associated with more frequent nocturnal voiding. The aim of this study is to assess the impact of non-dipping orthostatic BP in hypertensives on nighttime and daytime urine production. METHODS: Participants with a diagnosis of essential hypertension had in-office supine and standing BP recordings and completed 24-hour urine collection and voiding diaries. Urine was collected in 3 containers; one for the first nighttime void, a second for all subsequent nighttime voids and first morning void, and a third for all daytime voids. Participants whose systolic BP decreased with supine positioning were placed in the orthostatic dip group, and participants whose systolic BP increased or was unchanged upon supine positioning were placed in the no orthostatic dip group. RESULTS: There were 12 (9 female) individuals in the dipping group and 19 (13 female) in the non-dipping group. The non-dipping group tended to produce greater volumes of urine both day and night, and had greater 24-hour urine sodium excretion. The sodium concentration of the first nighttime void was significantly higher in the non-dipping group (median: 102; IQR: 76-105 mEq/L) than the dipping group (median: 51; IQR: 32.5 - 65 mEq/L) (p=.024). This urine sodium concentration for the remainder of the night was significantly higher in the non-dipping group (median: 92; IQR: 62-117 mEq/L) than the dipping group (median: 59.5; IQR: 48-77.25 mEq/L) (p=.012). Subjects in the non-dipping group were 79% more likely to experience 2 or more nighttime voids compared to the dipping group (RR: 1.79; 95% CI: 1 – 3.2; p=.052). CONCLUSIONS: An in-office BP measurement that does not dip with supine positioning is associated with more frequent nighttime voiding as well as higher urine concentrations of sodium in both early and late-night voids. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e24 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Boroda More articles by this author Susan Gong More articles by this author Frederick Okoye More articles by this author Syed Rahman More articles by this author Matthew Moy More articles by this author Alla Akivis More articles by this author Jason Lazar More articles by this author Jeffrey Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

Systematic review and meta-analysis of randomized control trials addressing efficacy and safety of desmopressin for females with nocturia

Aim:To conduct a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that evaluated the efficacy and safety of desmopressin versus placebo among females with nocturia. Methods:PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar databases were searched from inception until 15-November-2022. The included studies were evaluated for risk of bias (Cochrane Tool). The endpoints were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Subgroup analysis based on the dose of desmopressin ( ≤50μg and >50μg) was conducted. In addition, meta-regression was performed to examine the impact of age and body mass index (BMI) on the endpoints. Results:Nine RCTs with 2852 patients (desmopressin=1110, placebo=1742) were analyzed. The overall risk of bias was low. Compared with placebo, desmopressin significantly reduced the mean number of nocturnal voids (MD=-0.51, 95% CI [-0.70, -0.31], p<0.001), prolonged the duration of the first sleep period (MD=69.06 min, 95% CI [46.54, 91.59], p<0.001), and increased the 33% responder rate (RR=1.30, 95% CI [1.13, 1.50], p<0.001). Subgroup analyses according to desmopressin dose ( ≤50μg and >50μg) showed similar significant differences compared with placebo. Meta-regression showed less improvement in the number of nocturnal voids with the increased age and BMI. There was no significant difference between both groups regarding the rate of overall adverse events (RR=1.11, 95% [0.94, 1.32], p=0.22). Conclusion:Desmopressin was safe and effective in improving nocturia among females. Higher dose of desmopressin (>50μg) correlated with better efficacy. Age and BMI impacted the mean number of nocturnal voids.

Clinical and Urodynamic Determinants of Earlier Time to Failure for the Artificial Urinary Sphincter

ObjectiveTo determine clinical, surgical and urodynamic attributes associated with earlier AUS reintervention. The artificial urinary sphincter (AUS) is the gold standard treatment for postprostatectomy stress urinary incontinence. Factors impacting long-term device survival have not been investigated. Materials and MethodsWe identified men with post-prostatectomy incontinence who underwent AUS reintervention from 2011 to 2021 at a single center. Urodynamic study, pad weights and voiding diaries are routinely assessed prior to AUS placement. Relationships between clinical, urodynamic and surgical variables and AUS reintervention were assessed using cox regression. Multiple imputation of chained equations was used to handle missing data elements, with truncated linear regression for continuous variables and logistic regression for binary variables. ResultsA total of 524 records were reviewed and 92 met inclusion. Median time to AUS reintervention was 5.7 years (2.3, 9.4). Indications were mechanical failure (38; 41.3%), sub-cuff atrophy (37; 40.2%), erosion/infection (11; 11.9%) and other (6; 6.5%). On univariable testing, earlier intervention was associated with pad weight (P < .01), nocturnal voids (P = .01), bladder capacity (P = .01), bladder volume at strong sensation (P = .03), detrusor overactivity (P < .01) and maximum voiding pressure (P = .02). On multivariable analysis, earlier surgical intervention was associated with detrusor overactivity (HR 1.95, P < .01 CI 1.22-3.1) and pad weight (HR 1.0006, P = .02, CI 1.000-1.001). ConclusionsDetrusor overactivity is associated with significantly shorter time to AUS failure. This information may allow for more individualized counseling.

Nocturnal polyuria in women: results from the EpiNP study.

Data from a large US population-based, cross-sectional, epidemiological study (the EpiNP Study) were used to assess the symptoms and bother experienced by women with nocturnal polyuria (NP). Consenting participants recruited from an online panel completed the baseline EpiNP survey online (Lower Urinary Tract Symptoms Tool and urological comorbidities). All reporting ≥2 voids/night and a random sample of 100 respondents, each reporting 0 or 1 void/night were asked to complete a 3-day web-based bladder diary recording time, volume, and urgency rating of each void. NP was calculated by the proportion of urine production that occurred during nocturnal hours using a Nocturnal Polyuria Index (NPI33) threshold of >0.33 or nocturnal urine production of >90 ml/h (NUP90). The frequency of participants reporting LUTS and bother was determined by age and NP: idiopathic NP, NP associated with overactive bladder (NPOAB), NP associated with comorbidities (NPCom), and no NP (did not meet NP criteria). A total of 5,290 women completed the baseline survey. Mean age (range) was 54.9 (30-95) years; 1,841 (34.8%) reported ≥2 nocturnal voids. The prevalence of LUTS increased across the lifespan; however, bother associated with each LUTS decreased with increasing age. The percentage of women rating bother by nocturia episodes ≥2 "> somewhat" ranged from 40.3% to 68.3%, with bother ratings highest in the NPOAB and No NP groups. NP is prevalent in women with considerable bother and is often associated with other urinary symptoms. Multifactorial causes and potential treatments of NP should be considered, particularly at a later age.

Evening home blood pressure and pulse rate: age-specific associations with nocturia severity.

Previous studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology associated with pulse rate (PR) remains unclear. In the Japan Morning Surge-Home Blood Pressure Study, a self-administered nocturia questionnaire and evening home blood pressure (BP) and PR measurements (taken on a mean of 11.2 days) were performed on 4310 patients with one or more cardiovascular risk factors (mean: 64.9 years old; 47% male). According to the number of nighttime voids, the study population was divided into three groups (no voids: n = 2382; 1 void: n = 847; ≥2 voids per night: n = 1082). In the multinomial logistic regression analysis adjusted for confounders, diuretic use (OR, 1.23; 95%CI, 1.01-1.50; p < 0.05) was significantly associated with one nocturnal void, whereas evening home systolic BP (SBP) (OR per 1 SD, 1.14; 95%CI, 1.05-1.24; p < 0.01) and evening home PR (OR per 1 SD, 1.12; 95%CI: 1.02-1.24; p < 0.05) were significantly associated with multiple nocturnal voids. In the younger group (<65 years), only evening home PR was significantly related to multiple nighttime voids (p < 0.01), whereas in the older group (≥65 years), only evening home SBP was significantly related to multiple nighttime voids (p = 0.02). In this study, both higher evening home PR and higher evening home SBP were associated with multiple nighttime voids, with the former playing a greater role in the younger participants, and the latter more often associating the older group. An age-stratified approach to reduce the burden of BP or PR might be important to improve sleep quality.

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications ("Sleep C.A.L.M.") in the evaluation and management of nocturia: A simple approach to a complex diagnosis.

Nocturia arises from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture, which may be driven by abnormalities of the genitourinary tract, but also by sleep disorders, medical diseases, patient actions/lifestyle factors, or medications. This article introduces a novel system for organizing the complex differential diagnosis for nocturia, as proposed by an international collective of practicing urologists, physician specialists, and sleep experts: "Sleep CALM"-Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications. Narrative review of current evidence regarding the relevance of each "Sleep CALM" factor to nocturia pathogenesis, evaluation, and management. Nocturia and sleep disorders are highly intertwined and often bidirectional, such that nocturnal awakenings for reasons other than a sensation of bladder fullness should not be used as grounds for exclusion from nocturia treatment, but rather leveraged to broaden therapeutic options for nocturia. Nocturia is an important potential harbinger of several serious medical conditions beyond the genitourinary tract. Urologists should have a low threshold for primary care and medical specialty referral for medical optimization, which carries the potential to significantly improve nocturnal voiding frequency in addition to overall health status. Adverse patient actions/lifestyle factors, lower urinary tract dysfunction, and medication use commonly coexist with disordered sleep and comorbid medical conditions, and may be the primary mediators of nocturia severity and treatment response, or further exacerbate nocturia severity and complicate treatment. "Sleep CALM" provides a memorable and clinically relevant means by which to structure the initial patient history, physical exam, and clinical testing in accordance with current best-practice guidelines for nocturia. Although not intended as an all-encompassing diagnostic tool, the "Sleep CALM" schema may also be useful in guiding individualized ancillary testing, identifying the need for specialty referral and multidisciplinary care, and uncovering first-line treatment targets.