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

2020 ◽  
Vol 9 (7) ◽  
pp. 2262
Author(s):  
Tine Olesen ◽  
Jerome Paul ◽  
Pierre Gramme ◽  
Marcus J. Drake ◽  
Johan Vandewalle ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Adult Population ◽  
Univariate Analysis ◽  
Urine Volume ◽  
Bladder Capacity ◽  
Nocturnal Polyuria ◽  
Disease States ◽  
Urine Production ◽  
Multivariate Modelling ◽  
Clinically Significant

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

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

2020 ◽  
Vol 9 (8) ◽  
pp. 2532
Author(s):  
Upeksha S. Alwis ◽  
Joris Delanghe ◽  
Lien Dossche ◽  
Johan Vande Walle ◽  
John Van Camp ◽  
...  
Keyword(s):  
Dietary Protein ◽  
Sodium Excretion ◽  
Protein Intake ◽  
Urine Volume ◽  
Free Water ◽  
Control Group ◽  
Dietary Protein Intake ◽  
Nocturnal Polyuria ◽  
Urea Excretion ◽  
Urine Production

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

scholarly journals Effects of desmopressin for the treatment of nocturnal polyuria in elderly women: impact on related sleep quality

2015 ◽  
Vol 9 (11-12) ◽  
pp. 770 ◽  
Author(s):  
Sun-Ouck Kim ◽  
Ho Song Yu ◽  
Ho Suck Chung ◽  
Dongdeuk Kwon
Keyword(s):  
Sleep Quality ◽  
Elderly Women ◽  
Urine Volume ◽  
Underlying Disease ◽  
Fluid Restriction ◽  
Nocturnal Polyuria ◽  
Duration Of Symptoms ◽  
Urine Production ◽  
Before And After ◽  
Total Urine

Introduction: We investigated the efficacy, safety, and impact of desmopressin on quality of sleep in treating nocturnal polyuria in elderly women.Methods: We recruited 60 women over 60 years old with lower urinary tract symptoms (LUTS), including nocturia, and with nocturnal polyuria. Nocturnal polyuria was defined as nighttime urine production exceeding 33% of the 24-hour total urine volume determined by a frequency volume (FV) chart. All patients failed to respond to treatment of their underlying disease and evening fluid restriction. Desmopressin 0.1 mg was administered orally at bedtime for 12 weeks. The participants completed a series of questionnaires on the Medical Outcomes Study (MOS) sleep scale and FV chart before and after treatment.Results: The patient population had a mean age of 69.2 ± 9.4 years (range: 61–81). The mean duration of symptoms was 61.2 ± 45.1 months. Significant decreases were evident after desmopressin treatment in the number of nocturia episodes (3.63 ± 1.61 to 2.00 ± 1.13, p = 0.01), nocturnal urine volume (p = 0.01), nocturnal polyuria index (NPI) (p = 0.01), and nocturia index (NI) p = 0.01). Among the categories of the MOS sleep scale, sleep index (p = 0.003), sleep disturbance (p = 0.001), snoring (p = 0.028), and shortness of breath (p = 0.036) significantly changed, with a decreased number of nocturia episodes. Adverse events were mild.Conclusions: Desmopressin is an effective treatment for nocturnal polyuria in elderly women, where conservative treatment has failed. Sleep quality is also improved.

scholarly journals Experience of cyclooxygenase inhibitor use for correction of urine overproduction in incontinent women

2018 ◽  
Vol 67 (1) ◽  
pp. 47-57 ◽  
Author(s):  
Natalya A. Osipova ◽  
Dariko A. Niauri ◽  
Alexander M. Gzgzyan
Keyword(s):  
Circadian Rhythm ◽  
Urine Volume ◽  
Thick Ascending Limb ◽  
Nocturnal Polyuria ◽  
Initial State ◽  
Urine Incontinence ◽  
Control Subjects ◽  
Therapy Effect ◽  
Urine Production ◽  
Sodium Magnesium

Hypothesis/aims of study. Questions of urine incontinence pathogenesis and ways of treatment are actively discussed by gynecologists, urologists and neuropathologists. Urine incontinence often has multifactor origin: the causes of urine incontinence are connected, as a rule, with violation of urine continence functional mechanisms, anatomical and topographical features of the lower urinary tract or an age failure of ovaries function. At the same time changes of kidneys function play part in urine incontinence pathogenesis. In some cases urine incontinence is combined with urine overproduction or inversion of circadian rhythm of renal function due to decrease in a reabsorption sodium ions in the thick ascending limb of a Henle’s loop. The reabsorption of Na+, K+, Ca2+, Mg2+, Cl– in this department of a nephron is increased by vasopressin activation of V2-receptors. In some patients we succeeded to normalize ions transport, diuresis, circadian rhythm of urine production by desmopressin administration, however in some cases significant decrease in a diuresis did not happen. The lack of therapy effect could be connected with local production of substances resisting to effect of this hormone, in particular prostaglandin E2. The current analysis was undertaken to evaluate the clinical efficiency of Diclofenac in incontinent patients with nocturnal polyuria and polyuria. Study design, materials and methods. A total of 44 patients with complaints of urinary incontinence, polyuria (24-urine volume of 40 mL/kg bodyweight or above) or nocturnal polyuria (nocturnal volume/24-h urine volume of 0.33 or above) (Van Kerrebroeck P., 2002) and 14 control subjects were included. Mean patient age was 42.8 ± 4.5 years, in control subjects 39.4 ± 6.3 (p > 0.05). All participants performed 72h-urinecollection to determine the voided volumes and the levels of creatinine, osmolality, sodium, magnesium and potassium for each sample. A blood sample was taken during the 72-urinecollection to determine the levels of creatinine, osmolality, sodium, magnesium and potassium. The examination of patients with polyuria and nocturnal polyuria was performed twice: in the initial state and one month after the start of treatment with optimal dose of Diclofenac. Results. In patients with polyuria and nocturnal polyuria the glomerular filtration rate was normal, whereas diuresis and solute (sodium, magnesium, potassium) clearance in night samples in nocturnal polyuria and both in night and day samples was higher. Diclofenac use had the normalizing effect on transport of ions in a nephron.

scholarly journals The association between nocturia, hormonal symptoms and bladder parameters in women: an observational study.

2020 ◽  
Author(s):  
Wendy Bower ◽  
Georgie Rose ◽  
David Whishaw ◽  
Claire Ervin ◽  
Audrey Wang ◽  
...  
Keyword(s):  
Vitamin D ◽  
Urine Volume ◽  
Cross Sectional Study ◽  
Vitamin D Supplementation ◽  
Nocturnal Polyuria ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Bladder Diary ◽  
Urine Production ◽  
Post Menopausal

Objective Post-menopausal nocturia is poorly understood. This study aimed to identify hormonal and lifestyle factors associated with nocturia and to understand the relative contribution of altered urine production and bladder storage dysfunction in women. Design, setting, population and methods Women ≥40 years presenting to public continence services were enrolled in a cross-sectional study. 153 participants completed a hormone status questionnaire, a validated nocturia causality screening tool and a 3-day bladder diary. Descriptive statistics and logistic regression models for nocturia severity and bladder diary parameters were computed. Results Overall, 91.5 % reported nocturia, 55% ≥2 /night. There was a difference of 167.5 mL (p<0.001) in nocturnal urine volume between women with nocturia ≥2 (median 736mL) vs less often (517mL). Significant predictors of self-reported disruptive nocturia were age (OR 1.04, 95%CI 1.002-1.073) and vitamin D supplementation (OR 2.33, 95%CI 1.11-4.91). Nocturnal polyuria was significantly more common with nocturia ≥2 compared to less often (p<0.002). 150 minutes of exercise per week was protective for nocturnal polyuria (OR 0.22, p=0.001). Nocturia index >1.3 was significantly predicted by age (OR 1.07, p<0.001), regular exercise (OR 0.41, p=0.036), day flushes (OR 4.00, p=0.013) and use of Vitamin D (OR 2.34, p=0.043). Maximum voided volumes were significantly lower with nocturia≥2 vs less often (night: 268ml vs 350mL; day: 200mL vs 290mL). Conclusions Bothersome nocturia in post-menopausal women is associated with changes to both nocturnal diuresis and bladder storage. Regular physical activity, prolapse reduction and oestrogen replacement may be adjunctive in managing bothersome nocturia in women.

scholarly journals Clinical efficiency of desmopressin and cyclooxygenase inhibitor use in incontinent women

2018 ◽  
Vol 67 (2) ◽  
pp. 40-51
Author(s):  
Natalya A. Osipova ◽  
Dariko A. Niauri ◽  
Alexander M. Gzgzyan
Keyword(s):  
Circadian Rhythm ◽  
Comparison Group ◽  
Urine Volume ◽  
Control Group ◽  
Thick Ascending Limb ◽  
Nocturnal Polyuria ◽  
Initial State ◽  
Urine Incontinence ◽  
Clinical Efficiency ◽  
Urine Production

Hypothesis/aims of study. Questions regarding the pathogenesis of urine incontinence and methods of treatment are acti vely discussed by gynecologists, urologists, and neuropathologists. Urine incontinence often has multifactor origins: the causes of urine incontinence are connected, as a rule, with the violation of urine continence functional mechanisms, anatomotopographical features of the lower urinary tract, or an premature ovarian failure. Simultaneously, changes in kidney function play a role in the pathogenesis of urine incontinence. In some cases, urine incontinence is combined with urine overproduction or inversion of the circadian rhythm of renal function owing to a decrease in the reabsorption of sodium ions in the thick ascending limb of the loop of Henle. In some patients, we successfully normalized ion transport, diuresis, and circadian rhythm of urine production by desmopressin or diclofenac administration. The present analysis was undertaken to evaluate the clinical efficiency of desmopressin and diclofenac in incontinent patients with nocturnal polyuria and polyuria. Study design, materials, and methods. In total, 130 patients with complaints of urinary incontinence, polyuria (24-h urine volume of 40 mL/kg bodyweight or above), or nocturnal polyuria (nocturnal volume/24-h urine volume of 0.33 or above); 30 incontinent women without polyuria or nocturnal polyuria (comparison group); and 14 control subjects were included. The mean patient age was 43.6 ± 4.5 years (41.8 ± 3.7 years in the comparison group and 39.4 ± 6.3 years in the control group, p > 0.05). All the participants performed seven days of urine collection to determine the voided volumes. Patients with polyuria or nocturnal polyuria performed the 3-fold 24-h pad-test. Patients with polyuria and nocturnal polyuria were examined twice: in the initial state and one month after the start of treatment with the optimal dose of diclofenac or desmopressin (Minirin). Results. The use of both diclofenac or desmopressin in patients with various types of urine incontinence, polyuria, or nocturia decreased the volume of voided urine because of the normalization of diuresis and an increase in cystometric bladder capacity.

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

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A384-A385
Author(s):  
T F Monaghan ◽  
C W Agudelo ◽  
S N Rahman ◽  
K P Michelson ◽  
J M Lazar ◽  
...  
Keyword(s):  
Urine Volume ◽  
Free Water ◽  
Bladder Capacity ◽  
Flow Volume ◽  
Clock Time ◽  
Sleep Period ◽  
Urine Production ◽  
Quality Sleep ◽  
Capacity Data ◽  
Voided Volume

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 [&gt;90 ml/hr] [n=49] vs low [&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 &gt;90 ml/hr vs &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&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

scholarly journals Comparison of Nocturia Response to Desmopressin Treatment between Patients with Normal and High Nocturnal Bladder Capacity Index

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Tine Hajdinjak ◽  
Jurij Leskovar
Keyword(s):  
Retrospective Analysis ◽  
Urine Volume ◽  
Bladder Capacity ◽  
Adult Patients ◽  
Nocturnal Polyuria ◽  
Clinical Consequences ◽  
Capacity Index

Objective. To compare efficacy of desmopressin for treatment of nocturia between patients with normal and high nocturnal bladder capacity index (NBCi).Methods. Retrospective analysis of adult patients treated with desmopressin for nocturia. Patients were analyzed according to high or normal NBCi value before treatment.Results. 55 patients were identified, aged 49–84, 47 males, 8 females, who started desmopressin 0.2 mg nocte between 2009 and 2011. Two groups (N: normal and H: high NBCi) were similar regarding number, gender, age, 24 h urine volume, and nocturnal urine volume. On treatment, nocturnal volume decreased by mean of 364 mL. Number of nightly voids decreased in N group from 3.11 to 1.50, in H from 3.96 to 1.44. Nocturnal polyuria and nocturia indices also decreased significantly. NBCi remained the same in N group (0.56 on therapy) and in H group decreased to mean 0.63. All on-treatment values were statistically similar in N and H groups. Pretreatment differences were abolished with treatment. NBCi was significantly correlated to nocturia reduction—larger reduction was observed in patients with higher NBCi. In 8/55 patients, hyponatremia was detected, but without clinical consequences.Conclusions. The results indicate that the effectiveness of desmopressin on nocturia is not dependent upon the patient's pretreatment NBCi.

scholarly journals Nocturnal Urine Production in Women With Global Polyuria

2020 ◽  
Vol 24 (3) ◽  
pp. 270-277
Author(s):  
Thomas F. Monaghan ◽  
Adriana M. Kavoussi ◽  
Christina W. Agudelo ◽  
Syed N. Rahman ◽  
Kyle P. Michelson ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Urine Volume ◽  
Full Length ◽  
Nocturnal Polyuria ◽  
Distinct Entity ◽  
Common Criteria ◽  
Urine Production ◽  
Voiding Diary ◽  
Rule Out

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

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