Number Of Nocturia Episodes Research Articles

Androgenic Alopecia Is Associated With More Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

To evaluate the possible association between androgenic alopecia (AGA) and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). A total of 148 patients aged over 45 with LUTS secondary to BPH were prospectively enrolled in this study. According to the Norwood-Hamilton classification, the patients were divided into two groups: AGA (n = 69) and non-AGA (n = 79). In addition, the cases of AGA were categorized as vertex (n = 39) and frontal baldness (n = 30). The International Prostate Symptom Score (IPSS), uroflowmetry parameters, prostate volume, serum total testosterone (TT), and free and total prostate-specific antigen concentrations of all patients were assessed and compared between the groups. Correlations between the AGA grade and other variables were also investigated. The serum TT level (354 ± 97.1 vs. 308.6 ± 73.1 ng/dL, p = 0.01), total IPSS (16.1 ± 8.1 vs. 13.4 ± 7.7, p = 0.04), IPSS storage subscore (IPSS-S) (7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03), and number of nocturia episodes (2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01) were significantly higher in the AGA group than in the non-AGA group. There were no significant differences in any of the parameters between the patients with vertex and frontal baldness. The AGA grade showed a significant positive correlation with the TT level (r = 0.407, p = 0.003), IPSS-S (r = 0.164, p = 0.04), and number of nocturia episodes (r = 0.203, p = 0.015). This study demonstrated that among patients with LUTS, those with AGA had worse symptoms and higher TT levels compared with those without AGA of similar age. Furthermore, the AGA grade was positively correlated with the TT level and storage symptoms.

The efficacy and safety of medication for treating overactive bladder in patients with Parkinson's disease: a meta-analysis and systematic review of randomized double-blind placebo-controlled trials.

The goal of this meta-analysis was to determine the efficacy and safety of medication for treating overactive bladder (OAB) in patients with Parkinson's disease (PD). Papers containing predefined key terms were searched in the PubMed, Embase, Web of Science, and Cochrane Library databases up to December 2021 to collect randomized double-blind placebo-controlled trials (RCTs). The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Two reviewers independently assessed the risk of bias using the modified Jadad scale and Cochrane risk-of-bias tool. The GRADEpro GDT was employed to evaluate the strength of evidence based on the findings of this meta-analysis. We eventually included four RCTs involving 313 patients (163 patients in the medication group and 150 patients in the placebo group). Of these, the therapeutic agent in two RCTs was mirabegron (121 and 106 patients and controls, respectively, representing 3/4 -2/3 of the patients). The results showed that the number of micturition episodes per 24h (MD -1.33; 95% CI -2.30 to -0.36; p = 0.007), the number of nocturia episodes per 24h (MD -0.33; 95% CI -0.58 to -0.08; p = 0.009) and the number of urinary incontinence episodes per 24h (MD -0.72; 95% CI -1.32 to -0.12; p = 0.02) were significantly lower in the medication group than in the placebo group. The OAB symptom score (MD -2.84; 95% CI -4.67 to -1.00; p = 0.002) and quality of life score (MD 15.15; 95% CI 12.33 to 17.96; p < 0.0001) of the medication group were significantly improved compared with those of the placebo group. However, no significant difference in the daily frequency of urinary urgency episodes was identified between the medication group and the placebo group (MD -0.79; 95% CI -1.71 to 0.14; p = 0.09). There were no significant differences between the two groups in terms of drug-related adverse events (OR 1.69; 95% CI 0.41 to 6.99; p = 0.47), especially in PD patients receiving mirabegron therapy. Medication was effective for OAB symptoms in patients with PD, and patients tolerated adverse events well.

Calcium Channel Blockers Are Associated with Nocturia in Men Aged 40 Years or Older.

Background: The associations of nocturia with hypertension and anti-hypertensive agents (AHTs) remain to be validated. Methods: This cross-sectional study examined whether blood pressure and/or frequently used classes of AHTs had consistent associations with nocturia. Methods: A total of 418 male patients aged ≥ 40 years were retrospectively assessed in terms of the International Prostate Symptom Score (IPSS), prescription medications, and blood pressure. Nocturia was evaluated using item 7 of the IPSS, and two or more episodes of nocturia per night was considered to indicate clinically important nocturia. Results: Patients taking calcium channel blockers (CCBs), but not other AHTs, experienced more episodes of nocturia than patients not taking AHTs (1.77 ± 1.07, 1.90 ± 1.19, and 1.48 ± 0.98 in CCBs alone, CCBs + other AHTs, and other AHTs alone, vs. 1.35 ± 1.08 in not taking AHTs; p = 0.014, p < 0.0001, and p = 0.91, respectively), whereas there was no significant difference in the number of nocturia episodes between patients with elevated and normal blood pressure. In multivariate analysis, CCB (odds ratio (OR) = 2.68, p < 0.0001) and age (OR = 1.06, p < 0.0001) were independently associated with clinically important nocturia. Conclusion: CCB was associated with nocturia, while AHTs other than CCBs and elevated blood pressure were not.

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

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

Bladder sensations in women with nocturia due to overactive bladder syndrome.

Nocturia is the number of times urine is passed during main sleep. This definition tells us that it is a need to void; it does not tell us what triggers it. The aim of this study is to report bladder sensations that wake up women with nocturia (N). Descriptions of sensations in relation to various overactive bladder (OAB) symptoms, most bothersome symptoms, urinary incontinence (UI) and urodynamic findings are examined. A prospective study of women > 18years old presenting with OAB and nocturia. Data collected included presenting and most bothersome symptoms, descriptions of bladder sensations associated with nocturia, number of frequency and nocturia episodes, nighttime UI and urodynamic findings. One hundred fifty women were recruited with mean age 52years, mean duration of symptoms 10.5months and mean number of nocturia episodes 4.5. All women reported multiple presenting and bothersome symptoms. Fifty-five per cent had detrusor overactivity (DO). "Multiple" and "more intense" bladder sensation descriptions of nocturia were associated with advanced age, more frequent nighttime UI, when nocturia was considered most bothersome and in the presence of DO. The most frequent single description was "strong desire to void". The most frequently used combination was "strong desire to void, sudden compelling desire to void, bladder pain and full bladder". Descriptions of bladder sensations associated with nocturia in women with OAB were diverse and overlapping. It is important to report clinically and in research why patients have nocturia as this will have bearing on its treatment.

The effect of continuous positive airway pressure on nocturia in patients with obstructive sleep apnea syndrome.

The prevalence of nocturia in patients with obstructive sleep apnea syndrome (OSAS) who received continuous positive airways pressure (CPAP) treatment was studied as well as the effect of CPAP treatment on nocturia. All patients that were referred to the pulmonology department of a large teaching hospital in the Netherlands and received a CPAP mask for OSAS were interviewed and invited to take part in the study (N = 274). After informed consent, all patients were asked about the number of nocturia episodes before and after CPAP. In this prospective analysis, 274 patients (190 male and 84 female) were included. The mean age was 60.3 years (SE = 0.7). Sixty-four patients (23.4%) reported no nocturia episodes before CPAP and 210 patients (76.4%) reported ≥1 nocturia episode(s). Treatment of OSAS with CPAP reduced nocturia with one or more episodes per night in 42.3% of the patients. Clinically relevant nocturia (≥2 voids per night) was reduced from 73.0% to 51.5%. There were no statistically significant gender differences. The prevalence of nocturia in patients diagnosed with OSAS is 75.8% in both sexes. After treatment with CPAP, almost half of patients experienced a decrease in the nocturia frequency of one or more voids. Clinically relevant nocturia was reduced with one-third after CPAP. CPAP not only reduced the number of voids during the nightbut also improved the associated quality of life.

Changes in uroplakin expression in the urothelium of patients with ulcerative interstitial cystitis/bladder pain syndrome.

PurposeWe evaluated changes in the expression of uroplakin (UP) in the urothelium of patients with ulcerative interstitial cystitis/bladder pain syndrome (IC/BPS).Materials and MethodsBladder samples were collected from 19 patients with ulcerative IC/BPS who were treated with augmentation ileocystoplasty and from 5 control patients. Frequency-volume charts, the pain visual analogue scale (VAS), and the O'Leary-Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate the patients' symptoms preoperatively. The expression levels of UP-Ib and UP-III in the urothelium were compared between the IC/BPS patients and control patients.ResultsSixteen women and three men with IC/BPS were evaluated. Their values for preoperative mean voiding frequency, number of nocturia episodes, and functional bladder capacity as recorded in frequency-volume charts were 21.1±12.8, 5.9±4.2, and 151.1±62.7 mL, respectively. The mean pain VAS, ICSI, and ICPI scores were 8.4±1.3, 17.7±2.2, and 14.7±1.8, respectively. Immunofluorescence staining showed that UP-Ib and UP-III were localized in the urothelium. Upon Western blot analysis, the expression of UP-III was significantly increased in the IC/BPS group compared with the control group. However, expression of UP-Ib did not differ significantly between the IC/BPS and control groups.ConclusionsUP-III was significantly upregulated in patients with ulcerative IC/BPS. UP-III is a potential biomarker for the diagnosis of ulcerative IC/BPS.

Randomized, controlled trial of fesoterodine fumarate for overactive bladder in Parkinson's disease.

To evaluate short-term efficacy and safety of fesoterodine fumarate in Parkinson's disease (PD) patients with overactive bladder (OAB) symptoms. This is a randomized, double-blind, placebo-controlled study. It also has an open-label extension phase. From May 2016 to May 2018, 63 patients were randomized to receive fesoterodine 4mg or placebo for 4weeks. At the end of 4weeks of randomization phase, patients were received fesoterodine fumarate 4mg daily for another 4 weeks at the open-label extension phase. The change in the mean number of micturition episodes per 24h period was the primary outcome measure of the study. The number of micturition episodes per 24h period significantly improved with the use of fesoterodine fumarate in the double-blind phase (p < 0.001). Also the mean number of nocturia and urgency episodes decreased in the fesoterodine group. In the open-label phase, the mean number of micturition, urgency and urgency urinary incontinence episodes were improved significantly. The number of nocturia episodes did not change in the open-label phase. Cognitive functions were stable after 4weeks of fesoterodine 4mg treatment. OAB symptoms were significantly improved in older adults with PD under fesoterodine fumarate treatment, and this advantage continued in the open-label portion in the short term. In this randomized controlled study, the cognitive functions of the participants were not affected by fesoterodine 4mg treatment compared with placebo.

Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort

IntroductionThis study aimed to assess the outcomes of mirabegron for the treatment of overactive bladder (OAB) symptoms in patients with Parkinson disease (PD). MethodsA retrospective study was conducted including patients with PD who received mirabegron 50 mg once daily for OAB symptoms between 2012 and 2017. The primary endpoint was clinical success defined as any improvement in overactive bladder symptoms self-assessed by the patients 6 weeks after mirabegron initiation. Secondary endpoints included number of pads per day, number of nocturia episodes and adverse events. ResultsFifty patients (mean 74 years old) were included. Before being treated with mirabegron, 56% had failed prior anticholinergic therapy. After 6 weeks of mirabegron 50 mg, five patients (11.4%) had a complete resolution of their OAB symptoms; 25 patients (50%) reported improvement, 23 (46%) reported no change and 2(4%) reported worsening of their OAB symptoms. The number of pads per day decreased from 1.5 to 0.9 (p = 0.01) and so did the number of nocturia episodes (from 3 to 2.6/night; p = 0.02). Only 2 adverse events were reported during mirabegron treatment (4%): one dizziness and one diaphoresis, that disappeared after mirabegron discontinuation. After a median follow-up of 19 months, 23 patients (46%) persisted on mirabegron. Persistence rates were 51.5%, 44.6% and 36.4% at 1, 2 and 3 years respectively. ConclusionMirabegron has an excellent safety profile and appears to be an effective treatment for overactive bladder symptoms in patients with PD. Further prospective randomized trials are needed to properly assess mirabegron in PD patients.

149 Nocturia is Significantly Associated with Depressive Symptoms in Caucasian-European Men Seeking Medical Help for Sexual Dysfunction Without Known Psychiatric Disorders

We aimed to investigate the association between nocturia and mood impairment in a homogeneous cohort of Caucasian-European men seeking medical help for solitary erectile dysfunction (ED) as a primary reason for office evaluation, without any known psychiatric disorders. Data from 426 patients with ED were analysed. Patients completed the Beck’s inventory for Depression (BDI), the International Index of Erectile Function (IIEF) and the International Prostatic Symptoms Score (IPSS). Depressive symptoms (DS) were considered for BDI≥11, with clinical depression (CD) defined as a BDI score ≥16. Nocturia was defined as ≥2 nocturnal voiding episodes. The number of nocturia episodes was assessed using IPSS question 7. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Testosterone deficiency (TD) was defined as tT <3.5 ng/mL. Descriptive statistics and logistic regression models tested the association between nocturia and DS and/or CD. Overall, mean (SD) age was 47.6 (14.1) yrs and mean tT value was 4.9 (2.9) ng/mL; TD was observed in 90 (21.2%) patients. Mean BDI was 7.23 (7.2); BDI scores suggestive for DS and CD were observed in 107 (25.1%) and 51 (12.0%) patients, respectively. Of all, 66 (15.6%), 59 (13.9%), 69 (16.1%) and 133 (31.2%) men had mild, mild-to-moderate, moderate and severe ED, respectively. Nocturia was reported in 150 (35.2%) men. Patients with nocturia showed higher rate of obesity (p=0.02), BDI scores suggestive for either DS (31.3% vs. 21.7%; p=0.029) or CD (18.7% vs. 8.3%; p=0.002) compared to patients without nocturia. No differences in terms of age, CCI, IIEF-EF and TD prevalence were observed between the two groups. At multivariable analysis, BMI (p=0.015), CCI (p=0.015), low IIEF-EF score (p=0.03) and nocturia (p=0.024) achieved independent predictor status for DS, after accounting for age and testosterone values. Conversely, only age (p=0.04), low IIEF-EF score (p=0.04) and nocturia (p=0.016) achieved independent predictor status for CD.

The Degree of Bother of Nocturea on Quality Of Life in a Group from Al-Diwaniya Population.

Nocturia is common and disrupts sleep. Traditionally,one nightly episode has been regarded as clinically meaningless.To evaluate the bothersome effect of nocturia on health related quality of life (HRQoL) in a group from Al-Diwaniya population. Patients and methods: In 2006–2008,a survey was made on a random sample of 600 patients aged 18–79 yr who were identified from Al-Diwaniya teaching hospital,proportion was 62% males and 38% were females).bother from nocturia on QoL were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Score). Bother from nocturia was assessed on a four-point scale (none,small,moderate,major). Degree of bother increased with nocturia frequency (p &lt; 0.01). The most commonly cited degree of bother for those with one,two,and three nightly voids was no bother,small bother,and moderate bother,respectively. At least two voids per night are bothersome and associated with impaired HRQoL. The majority of people report having bothered when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and,thus,is not a suitable criterion for clinically relevant nocturia.

Is It Worth Treating Non-Bothering Nocturia? Results of a Multicenter Prospective Observational Study.

PurposeThe purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia.Materials and MethodsIn this prospective multicenter study, patients who visited hospitals for treatment of voiding symptoms were enrolled. Inclusion criteria were: 1) men >45 years, and 2) nocturia ≥2 confirmed by a three-day voiding diary. Subjects were divided into non-bothering and bothering groups based on International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) question 2b. Changes in voiding symptoms, frequency of nocturia, and bothersomeness were evaluated with international prostate symptom score (IPSS), ICIQ-N, and three-day voiding diary at 4 and 12 weeks after treatment.ResultsA total of 48 patients in the non-bothering nocturia group and 50 patients in the bothering nocturia group who completed the 12-week treatment were analyzed. The total IPSS was decreased by 5.8 in the non-bothering group and 5.2 in the bothering group. There was no significant difference in decrease of IPSS between the two groups. Both groups showed significant reduction in discomfort of nocturia. The ICIQ-N 2b score decreased from 3.9 to 2.7 (p=0.01) in the non-bothering group and from 6.9 to 4.6 (p=0.02) in the bothering group. The number of nocturia episodes was significantly decreased in both groups.ConclusionsRegardless of discomfort associated with nocturia, both groups showed significant improvement in nocturia-related discomfort and voiding symptoms. These results suggest that patients with nocturia who were unaware of its discomfort benefited from treatment.

The Degree Of Bother Of Nocturea On Quality Of Life In A Group From Al-Diwaniya Population

Background: Nocturia is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless.Objective: To evaluate the bothersome effect of nocturia on health related quality of life (HRQoL) in a group from Al-Diwaniya population.Patients and methods: In 2006–2008, a survey was made on a random sample of 600 patients aged 18–79 yr who were identifiedfrom Al-Diwaniya teaching hospital, proportion was 62% males and 38% were females).Measurements: bother from nocturia on QoL were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Score). Bother from nocturia was assessed on a four-point scale (none, small, moderate, major). Results and limitations: Degree of bother increased with nocturia frequency (p &lt; 0.01). The most commonly cited degree of bother forthose with one, two, and three nightly voids was no bother, small bother, and moderate bother, respectively.Conclusions: At least two voids per night are bothersome and associated with impaired HRQoL. The majority of people report having bothered when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and, thus, is not a suitable criterion for clinically relevant nocturia.

Diagnostic and therapeutic recommendations for patients with nocturia.

IntroductionNocturia is defined as the urge to urinate at night when the micturition was directly preceded and followed by sleep. Due to its negative impact on the quality of life of patients, an effective treatment for this disease has become a significant therapeutic challenge. The aim of this article was to explain the main risk factors for the occurrence of nocturia and to present diagnostic and therapeutic schemes in the case of nocturnal polyuria (idiopathic night time polyuria).Material and methodsA review of the literature was carried out and the available guidelines of international science societies, which provided the basis for the above recommendations, were analyzed.ResultsDetailed medical history should include information concerning: lower urinary tract symptoms (including nocturia), underlying illnesses, urogenital disorders, previous surgeries and medications administered. Keeping a bladder diary is recommended. The physical examination, depending on the patient's gender, should include gynecological examination with pelvic organ prolapse assessment or prostate evaluation. In laboratory tests, a urinalysis may be used, in particular cases a cytological analysis of urine sediment may be carried out. In addition, a possible ultrasound and/or cystoscopy may be conducted. Nocturia therapy should begin with modifying dietary habits, including compliance with the fluid regimen, avoiding alcohol, coffee and tea. Moderate physical exercise is also recommended. The pharmacological treatment of nocturia caused by nocturnal polyuria is based on the use of desmopressin at a daily single dose of 25 µg for women and 50 µg for men. The use of desmopressin allows for the reduction in the number of nocturia episodes, as well as improves the overall quality of life and sleep. Treatment with desmopressin can also be considered as a form of therapy added in people with an overactive bladder or benign prostatic hyperplasia, in which nocturia is a significant clinical problem.ConclusionsDesmopressin is an effective and safe first-line treatment option in pharmacological therapy of nocturia caused by nocturnal polyuria.

Relationship between serum testosterone and nocturia in men without benign prostate enlargement.

Recent studies have focused on the relationship between nocturia and serum testosterone because testosterone is thought to be an important factor of prostate growth. However, it remains unclear whether altered serum concentrations of testosterone is associated with an increased risk of nocturia because patients who were taking diuretics or who had a large prostate, which may precipitate nocturia, were not excluded from most previous studies. We analyzed the clinical records of 596 non-benign prostatic enlargement (BPE) male patients to explore the relationship between serum total testosterone and nocturia. All patients were evaluated using a serum prostate-specific antigen (PSA) assay, measurement of serum total testosterone, transrectal ultrasonography, uroflowmetry, and a compilation of the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) questionnaires. Nocturia was defined as ≥2 nocturnal voiding episodes. The number of nocturia episodes was assessed using IPSS question 7. To evaluate the effect of serum testosterone on nocturia, multivariate regression analysis was performed including the covariates of age, IPSS, IIEF score, body mass index, PSA, prostate volume, and maximal urine flow rate. Based on multivariate linear analysis, serum testosterone level was not significantly associated with the severity of nocturia. However, with regard to the relationship between prevalence of nocturia and serum testosterone, prevalence of nocturia was significantly positively associated with age (OR=1.048, p=0.005), total IPSS (OR=1.217, p<0.001), and testosterone level (OR=1.150, p=0.041). Therefore, in men without an enlarged prostate, testosterone may play an opposing role in the etiology of nocturia.

Postoperative urinary incontinence exacerbates nocturia-specific quality of life after robot-assisted radical prostatectomy.

To elucidate the effect of postoperative urinary incontinence on nocturia-related quality of life after robot-assisted radical prostatectomy. A total of 100 consecutive patients who underwent robot-assisted radical prostatectomy completed a nocturia quality of life questionnaire score and a frequency-volume chart before and after surgery. These patients were divided into two groups by continence status (continent and incontinent) according to the number of pad exchanges per day and the 1-h pad test after surgery. Assessment was carried out before surgery, and then at 3 and 12 months after surgery. The Nocturia Quality of Life questionnaire total score and the Bother/Concern subscore were significantly lower in incontinent patients at 3 and 12 months after surgery (Nocturia Quality of Life questionnaire total score: Bother/Concern subscores P = 0.006: P = 0.04 at 3 months after surgery; and P = 0.04: P = 0.02 at 12 months). Both nocturnal maximum voided volume and nocturnal frequency were not significantly different between continent and incontinent patients. On multivariate analysis, nocturnal urinary frequency (P = 0.01) and urinary incontinence (P = 0.005) were significantly associated with nocturia-specific quality of life. Although the number of nocturia episodes was not significantly different between the continent and incontinent patients after surgery, the Nocturia Quality of Life questionnaire score was significantly worse in incontinent patients. In these patients, other than the number of nocturia episodes, psychological stress might worsen the Nocturia Quality of Life questionnaire score. Therefore, prevention of post-prostatectomy incontinence might be important to avoid aggravating the Nocturia Quality of Life questionnaire score.

Relationship between Serum Testosterone and Nocturia in Men without Benign Prostate Enlargement

Objective: To clarify the relationship between serum total testosterone and nocturia in males without an enlarged prostate. Design and Method: Among the 1029 male patients who visited our clinic for health screening from January 2010 to July 2014, 596 patients without benign prostate enlargement (BPE) were analyzed. To evaluate the effect of serum total testosterone on prevalence of nocturia and number of nocturia episodes, multivariate analyses were performed including the covariates of age, International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) score, body mass index, prostate specific antigen, prostate volume and maximal urinary flow rate. Results: Mean prostate volume was 21.70±4.34 ml and prevalence of nocturia (over 1 times/night) was 22.1%. Multivariate logistic regression analysis revealed positive associations of age (OR 1.048, P = 0.005), total IPSS (OR 1.217, P &lt;0.001) and testosterone level (OR 1.115, P = 0.041) with the prevalence of nocturia. Although the mean testosterone level was progressively elevated as the number of nocturia episodes increased, no consistent association with the number of nocturia episodes was seen for testosterone after adjusting for age, IPSS, IIEF score and maximal urine flow rate. Conclusions: Serum total testosterone level is significantly positively associated with the prevalence of nocturia. Therefore, in men without enlarged prostate, testosterone seems to have an opposing role in the etiology of nocturia.

Persistence of solifenacin therapy in patients with overactive bladder in the clinical setting: a prospective, multicenter, observational study.

The aim of this study was to evaluate the persistence with solifenacin therapy over a 12-month period in patients with overactive bladder (OAB). This is a 52-week long, multicenter, prospective, observational study. The subjects were individuals ≥18years old with OAB symptoms for ≥3months, characterised by a total OAB Symptom Score (OABSS) of ≥3 and OABSS urgency item score of ≥2. Patients were prescribed 5mg or 10mg of solifenacin once daily for OAB symptoms. Drug persistence, reasons for discontinuation and factors related to the persistence were evaluated. A total of 1018 patients (329 men, 689 women) with a mean age of 59years were included. The 52-week drug persistence rate was 22.1%. The drug persistence rates at 12, 24 and 36weeks were 72.4%, 45.8% and 31.1% respectively. The three most common reasons for discontinuing therapy included symptom improvement in 30.4%, lack of efficacy in 13.4%, and a switch to another antimuscarinic agent in 10.8%. Older patients (odds ratio=1.02, 95% CI: 1.01-1.04), and female patients (odds ratio=1.94, 95% CI: 1.37-2.75) were more likely to continue the medication over the 12-month period than were younger, male patients. The number of nocturia episodes was negatively correlated with drug persistence (odds ratio=0.83, 95% CI: 0.71-0.97). There was low persistence (22%) to solifenacin therapy for OAB symptoms over a 12-month period. Older patients, female patients and those with fewer episodes of nocturia were more persistent to therapy than were others.

Efficacy of Desmopressin to Treat Nocturnal Polyuria in Elderly Men: Effects on Sleep Quality

Background: We investigated the efficacy of desmopressin in elderly patients with nocturnal polyuria (NP) to evaluate its effects on sleep quality. Methods: Patients with NP (defined as the nighttime urine production >33% of total 24-hour urine volume determined from a frequency-volume chart) were recruited. Desmopressin (0.2 mg) was treated orally at bedtime for 12 weeks. The participants completed the Medical Outcomes Study (MOS) Sleep Scale. Results: The mean patient age was 62.7 ± 13.0 (range 42-78 years). The mean symptom duration was 42.2 ± 39.7 months. The number of nocturia episodes (from 3.49 ± 1.83 to 2.03 ± 1.35, p = 0.01), nocturnal urine volume (p = 0.01), NP index (p = 0.01), and nocturia index (p = 0.01) decreased significantly after treatment with desmopressin. Among the MOS Sleep Scale categories, hours slept/night (p = 0.042), shortness of breath (p = 0.019), and adequacy of sleep (p = 0.001) changed significantly with a decrease in the number of nocturia episodes. Adverse events were mild. Conclusions: Desmopressin is an effective treatment for NP and improved sleep quality in elderly men.

Randomized, controlled pilot trial of solifenacin succinate for overactive bladder in Parkinson's disease.

To evaluate the efficacy of solifenacin succinate in Parkinson's disease (PD) patients suffering from overactive bladder (OAB). Urinary dysfunction is a commonly encountered non-motor feature in PD that significantly impacts patient quality of life. This was a double-blind, randomized, placebo-controlled, 3-site study with an open label extension phase to determine the efficacy of solifenacin succinate in idiopathic PD patients with OAB. Patients were randomized to receive solifenacin succinate 5-10mg daily or placebo for 12 weeks followed by an 8-week open label extension. The primary outcome measure was the change in the mean number of micturitions per 24h period. Secondary outcome measures included the change in the mean number of urinary incontinence episodes and the mean number of nocturia episodes. Twenty-three patients were randomized in the study. There was no significant improvement in the primary outcome measure in the double-blind phase, but there was an improvement in the number of micturitions per 24h period in the solifenacin succinate group compared to placebo at a mean dose of 6mg/day (p=0.01). In the open label phase, the mean number of urinary incontinence episodes per 24h period decreased (p=0.03), as did the number of nocturia episodes per 24h period (p=0.01). Adverse events included constipation and xerostomia, which resolved after treatment was discontinued. In this pilot trial, solifenacin succinate treatment led to an improvement in urinary incontinence, despite persistence in other OAB symptoms.