Dutasteride Improves Nocturia but Does Not Lead to Better Sleep: Results from the REDUCE Clinical Trial.

PURPOSE: In men, complaints of nocturia causing poor sleep are often attributed to benign prostatic hyperplasia and treated with benign prostatic hyperplasia medications. We assessed whether treating lower urinary tract symptoms with dutasteride altered either nocturia or sleep quality using data from REDUCE. MATERIALS AND METHODS: REDUCE was a 4-year randomized, multicenter trial comparing dutasteride 0.5 mg/day vs placebo for prostate cancer chemoprevention. Study participants were men considered at increased risk for prostate cancer. Eligibility included age 50-75 years, prostate specific antigen 2.5-10 ng/ml, and 1 negative prostate biopsy. At baseline, 2 years and 4 years, men completed the International Prostate Symptom Score and Medical Outcomes Study Sleep Scale, a 6-item scale assessing sleep. To test differences in nocturia and Medical Outcomes Study Sleep Scale over time, we used linear mixed models adjusted for baseline confounders. Subanalyses were conducted in men symptomatic from lower urinary tract symptoms, nocturia, poor sleep, or combinations thereof. RESULTS: Of 6,914 men with complete baseline data, 80% and 59% were assessed at 2 and 4-year followup, respectively. Baseline characteristics were balanced between treatment arms. Dutasteride improved nocturia at 2 (-0.15, 95% CI -0.21, -0.09) and 4 years (-0.24, 95% CI -0.31, -0.18) but did not improve sleep. When limited to men symptomatic from lower urinary tract symptoms, nocturia, poor sleep or combinations thereof, results mirrored findings from the full cohort. CONCLUSIONS: In men with poor sleep who complain of nocturia, treatment of lower urinary tract symptoms with dutasteride modestly improves nocturia but has no effect on sleep. These results suggest men with poor sleep who complain of nocturia may not benefit from oral benign prostatic hyperplasia treatment.

Medical history of nocturnal enuresis during school age is an independent risk factor for nocturia in adults: The Nagahama study.

AIM: To evaluate the relationship between nocturia and medical history of nocturnal enuresis: two conditions where diurnal urination rhythm is disturbed. METHODS: The Nagahama study is a longitudinal population-based health survey involving people aged 30-75 years in Nagahama city, Japan. Our analysis included 5,402 participants who completed enuresis and International Prostate Symptom Score questionnaires. Associations between nocturnal enuresis and nocturia were evaluated cross-sectionally and longitudinally with three models: (1) univariate analysis; (2) adjusted for basic characteristics (e.g., age, sex, body mass index, activity, alcohol, and smoking); and (3) adjusted for basic and clinical variables (e.g., hyperglycemia, hyperlipidemia, hypertension, renal insufficiency, insomnia, obstructive sleep apnea, and mental health). RESULTS: In total, 1,613 participants (29.9%) had a medical history of enuresis. The mean night-time frequency was 0.73 at baseline and 0.85 at the 5-year follow-up. The cross-sectional analysis showed participants with a medical history of enuresis had night-time frequency more often than those without this history (0.84 vs. 0.68, p < .0001). Significant differences were observed in Models 2 (p < .0001) and 3 (p < .0001). The longitudinal analysis showed nocturia progression was significantly related to a history of enuresis, with odds ratios of 1.32 (p < .0001) in Model 1, 1.21 (p < .01) in Model 2, and 1.22 (p < .01) in Model 3. CONCLUSIONS: Medical history of enuresis during school age was significantly related to nocturia in adulthood in the cross-sectional analysis, and to progression to nocturia in the longitudinal analysis. These two conditions may possess a common causative association.

The effect of intravesical hyaluronic acid therapy on urodynamic and clinical outcomes among women with interstitial cystitis/bladder pain syndrome.

OBJECTIVE: Treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) is often delayed because of a lack of objective data during diagnosis. This study was conducted to determine the clinical validity of using urodynamic studies to investigate the effect of intravesical hyaluronic acid (HA) treatment among women with IC/BPS. MATERIALS AND METHODS: Thirty patients with IC/BPS undergoing 6-month intravesical instillation of HA were recruited. Pretreatment evaluation involved a urinalysis and urinary culture, urinary cytology, a 3-day voiding diary, and cystoscopy with hydrodistention of the bladder. Urodynamic study was performed before and after HA treatment. Symptomatic changes were assessed using a questionnaire covering lower urinary tract symptoms, the O'Leary-Sant symptom index and problem indexes (ICSI and ICPI), and the visual analog scale for pain and urgency. Patient demographics, urinary symptoms, ICSI/ICPI scores, pain and urgency scores, and urodynamic results before and after HA treatment were compared. RESULTS: Urinary frequency, nocturia, urgency, pelvic pain, bladder capacity, ICSI, and ICPI were significantly improved after HA treatment. Comparing urodynamic parameters, the volumes at first desire to void (FDV) and maximum cystometric capacity were significantly increased after HA treatment. Before HA treatment, a negative correlation existed between the ICSI and ICPI and urodynamic parameters, including maximum flow rate and bladder capacity, but there were no significant correlations after treatment. Before HA treatment, a negative correlation was discovered between nocturia and FDV. However, after HA treatment, there were no significant correlations between urinary symptoms and urodynamic parameters. CONCLUSIONS: Our results indicate that the improvement of urinary symptoms of IC/BPS after HA treatment is associated with increased FDV and maximum cystometric capacity. The value of FDV and the frequency of nocturia after treatment may become useful objective indicators for prognosis of IC/BPS.

New participant stratification and combination of urinary biomarkers and confounders could improve diagnostic accuracy for overactive bladder.

Overactive bladder (OAB) is a highly prevalent symptom complex characterised by symptoms of urinary urgency, increased frequency, nocturia, with or without urge incontinence; in the absence of proven infection or other obvious pathology. The underlying pathophysiology of idiopathic OAB is not clearly known and the existence of several phenotypes has been proposed. Current diagnostic approaches are based on discordant measures, suffer from subjectivity and are incapable of detecting the proposed OAB phenotypes. In this study, cluster analysis was used as an objective approach for phenotyping participants based on their OAB characteristic symptoms and led to the identification of a low OAB symptomatic score group (cluster 1) and a high OAB symptomatic score group (cluster 2). Furthermore, the ability of several potential OAB urinary biomarkers including ATP, ACh, nitrite, MCP-1 and IL-5 and participants' confounders, age and gender, in predicting the identified high OAB symptomatic score group was assessed. A combination of urinary ATP and IL-5 plus age and gender was shown to have clinically acceptable and improved diagnostic accuracy compared to urodynamically-observed detrusor overactivity. Therefore, this study provides the foundation for the development of novel non-invasive diagnostic tools for OAB phenotypes that may lead to personalised treatment.

Lifestyle habits associated with nocturnal urination frequency: The Nagahama study.

BACKGROUND: Nocturia is a risk factor for poor quality of life and increased mortality. This study was aimed to clarifying dietary habits, eating behaviors, and sleep characteristics associated with nocturia to identify modifiable lifestyle factors for nocturia. METHODS: This cross-sectional study included 5683 community residents (64.5 ± 7.7 years old). The frequency of nocturnal urination was recorded for 1 week using a sleep diary. The frequency of food intake, unfavorable eating behaviors, and sleep characteristics that may have influence on salt intake and wasting were obtained using a structured questionnaire. RESULTS: The frequency of nocturnal urination was increased with age (ß = .312, P < .001). Other basic factors associated with the frequency were the male sex (ß = .090), hypertension (ß = .038), sleep apnea (ß = .030), B-type natriuretic peptide level (ß = .089), and spot urine sodium excretion (ß = -.058). Dietary factors independently associated with nocturnal urination frequency were coffee (≥1 time/day: ß = -.059, P < .001) and green vegetable consumption (≥1 time/week: ß = -.042, P = .001), whereas habitual intake of dairy products, miso soup, and alcohol were not associated with urination frequency. Later bedtime was inversely associated with nocturnal urination frequency independent of sleep duration (before 23:00: ß = -.096; before 24:00: ß = -.225; after midnight: ß = -.240; all P < .001). CONCLUSION: Coffee and green vegetable consumption and later bedtime but not sleep duration are lifestyle factors associated with nocturnal urination frequency.

A modified clinical scoring system for bladder pain syndrome: Long term experience.

PURPOSE: To document a modified clinical scoring system in patients with bladder pain syndrome that increases weightage to pain and nocturia and includes measures for sexual dysfunction and psychological impact. The clinical outcome of a set combination of treatment modalities linked to the clinical score at entry was also made. METHODS: The new proposed scale was used to assess and treat 190 enrolled patients from January 2009 to September 30, 2017. The patients were evaluated using the new scoring system at the time of induction, after 1, 3 and 6 months after commencement of treatment. Thereafter, they were followed every 6 months. The new scoring system included increased weightage to pain and nocturia and added domains of sexual dysfunction and psychological impact. The patients were treated with a protocol followed by the authors and published in the year 2007. A pictorial linkage of treatment modalities used with the clinical score of the patient was also described. RESULTS: A total of 174 evaluable patients had a follow up between 6 and 105 months (mean 64 months). The patients had age distribution between 24 and 76 years and included 19 male patients. 154 out of 174 patients (88.5%) had good or excellent response to treatment using the proposed scale at the end of 6 months. CONCLUSIONS: The proposed clinical scale appeared to aid clinical stratification of severity of the disease at the induction and during follow up. The treatment protocol could be linked with the clinical score at the time of induction.

International Continence Society consensus on the diagnosis and treatment of nocturia.

INTRODUCTION: Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. METHODS: Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence-Research Society (ICI-RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI-RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). RESULTS: Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate-specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow-up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. CONCLUSION: A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.

The impact of nerve-sparing robot-assisted radical prostatectomy on lower urinary tract function: Prospective assessment of patient-reported outcomes and frequency volume charts.

AIMS: To elucidate the effects of a nerve-sparing (NS) procedure on lower urinary tract symptoms (LUTS) and urinary function after robot-assisted radical prostatectomy (RARP), the associations between the NS procedure and LUTS and urinary function were investigated. METHODS: The participants in this study were 200 consecutive patients who underwent RARP. These patients were categorized into unilateral and bilateral NS groups and the non-NS group. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, frequency-volume chart, uroflowmetry, 1-h pad test, and the 5-item International Index of Erectile Function (IIEF-5) questionnaire were evaluated before and after RARP. RESULTS: The total IPSS score was significantly lower in the unilateral (P = 0.03) and bilateral NS groups (P = 0.03) than in the non-NS group after RARP. Diurnal maximum voided volume (MVV) values were significantly greater in the bilateral NS group than in the non-NS group after RARP (P = 0.002). Nocturnal frequency was significantly decreased in the unilateral NS group than in the non-NS group after RARP (3 months P = 0.01, 12 months P = 0.01). Erectile function was significantly better in both the unilateral NS group (P < 0.0001) and the bilateral NS group (P = 0.02) than in the non-NS group 12 months after RARP. CONCLUSIONS: The NS procedure in RARP has the possibility to improve not only erectile function, but also LUTS, owing to both the increase of MVV and the decrease of nocturia. Therefore, the NS procedure is also recommended from the viewpoint of early improvement of LUTS and lower urinary tract dysfunction after RARP.

Fundamentals of terminology in lower urinary tract function.

AIMS: To summarize basic definitions in the International Continence Society (ICS) Standardization of Terminology in lower urinary tract (LUT) function and their application. METHODS: Fundamental terminology in the ICS Standardization of Terminology LUT Function was identified and summarized. RESULTS: Evaluation of LUT requires appreciation of symptoms, signs and urodynamic observations. Symptoms are categorized according to their occurrence during the micturition cycle into storage symptoms (eg, increased daytime frequency [IDF], urgency, nocturia, or incontinence) or voiding and post-voiding symptoms (eg, slow stream or post micturition dribbling). Several problems may be present, giving rise to symptom syndromes, notably overactive bladder (during the storage phase) or underactive bladder (during the voiding phase). Signs may be derived from a bladder diary or may be elicited on physical examination. Urodynamic observations may be made by assessing flow rate, and this is combined with pressure measurement when undertaking filling cystometry and pressure flow studies. Key elements of flow and pressure measurement are described. CONCLUSIONS: The review provides a succinct summary of symptoms, signs, and urodynamic observations as set out in the ICS Standard on LUT Function.

Pelvic floor muscle training for overactive bladder symptoms - A prospective study / Treinamento dos músculos do assoalho pélvico nos sintomas da bexiga hiperativa - Um estudo prospectivo

Summary Introduction: Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. Objective: To verify the effects of isolated PFMT on the symptoms of OAB. Method: Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss ≥ 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry); urinary symptoms (nocturia, frequency and urinary loss); degree of discomfort of OAB symptoms; and quality of life (Incontinence Quality-of-Life Questionnaire [I-QoL]). The PFMT program consisted of 24 outpatient sessions (2x/week + home PFMT). The Mann-Whitney and Wilcoxon tests (with a significance level of 5%) were used to analyse the data. Results: There was a significant improvement of the urinary symptoms to the pad test (5.8±9.7, p<0.001), urinary loss (0.7±1.1, p=0.005) and nocturia (0.8±0.9, p=0.011). Reduction in the degree of discomfort of urinary symptoms was observed according to OAB-V8 questionnaire (10.0±7.7, p=0.001). There were also significant results in PFMs function: Oxford (3.6±0.9, p=0.001), endurance (5.2±1.8, p<0.001), fast (8.9±1.5, p<0.001) and manometry (26.6±15.8, p=0.003). In addition, quality of life had a significant improvement in the three domains evaluated by I-QoL. Conclusion: The PFMT without any additional guidelines improves the symptomatology, the function of PFMs and the quality of life of women with OAB symptoms.

Resumo Introdução: O treinamento dos músculos do assoalho pélvico (TMAP) envolve a contração dos músculos puborretal, esfíncteres anal e uretral externo, inibindo a contração do detrusor, o que justifica sua utilização no tratamento dos sintomas da bexiga hiperativa (BH). Objetivo: Verificar os efeitos do TMAP isolado sobre a sintomatologia da BH. Método: Ensaio clínico prospectivo com 27 mulheres com incontinência urinária mista (IUM), com predomínio de sintomas de BH e perda ≥ 2 g no pad test. Avaliaram-se: função dos músculos do assoalho pélvico (MAP) (palpação digital e manometria); sintomas urinários (noctúria, frequência e perda urinária); grau de incômodo dos sintomas de BH (Overactive Bladder Questionnaire [OAB-V8]); e qualidade de vida (Incontinence Quality-of-Life Questionnaire [I-QoL]). O programa de TMAP consistiu em 24 sessões ambulatoriais (2x/semana + TMAP domiciliar). Os testes de Mann-Whitney e Wilcoxon (com nível de significância de 5%) foram utilizados para analisar os dados. Resultados: Observou-se melhora significativa dos sintomas urinários ao pad test (5,8±9,7; p<0,001); ao diário miccional (perda urinária [0,7±1,1; p=0,005] e noctúria [0,8±0,9; p=0,011]). Foram observados redução do grau de incômodo dos sintomas urinários conforme questionário OAB-V8 (10,0±7,7; p=0,001) e significativos resultados na função dos MAP: Oxford (3,6±0,9; p=0,001), Endurance (5,2±1,8; p<0,001), Fast (8,9±1,5; p<0,001) e manometria (26,6±15,8; p=0,003). No mais, a qualidade de vida teve significativa melhora nos três domínios avaliados pelo I-QoL. Conclusão: O TMAP sem quaisquer orientações adicionais melhora a sintomatologia, a função dos MAP e a qualidade de vida de mulheres com sintomas de BH.

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

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

Treatment Patterns and Patient Reported Outcomes in Benign Prostatic Hyperplasia Patients with Overactive Bladder Symptoms.

OBJECTIVES: We aimed to examine the treatment patterns, and patient-reported outcomes (PROs) in benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) symptoms. METHODS: Seven hundred and forty seven patients were included in this prospective observational study. The primary endpoint was to describe the medical treatment patterns for BPH patients with OAB symptoms. The secondary endpoint was to determine the PROs of these patients. Clinical outcome was assessed using International prostate symptom score (IPSS), and PROs were measured using BPH-Related QoL Questionnaire Korea 1 (BPH QoL K1) and Euroqol-5 Dimension (EQ-5D). RESULTS: When starting the study, 391 patients (52.3%) received α-blocker monotherapy, whereas 356 (47.7%) received combination therapy with anticholinergics. Of the 369 patients who completed the 6-month treatment, 139 patients (37.7%) still received α-blocker monotherapy, 122 (33.1%) still received combination therapy with anticholinergics, and 108 (29.3%) received subsequent anticholinergics in addition to α-blocker. When the patients were stratified, storage subscore was higher (9.5 vs. 8.8, P = 0.034) and voiding subscore (9.7 vs. 11.6, P = 0.001) was lower in patients with anticholinergics than those without it. Although all treatment groups reported a significant improvement from baseline, no significant between-group differences in changes in IPSS, EQ-5D and BPH QoL K1 was found. CONCLUSIONS: About one-third of patients received α-blocker monotherapy, one-third received combination therapy with anticholinergics, and another one-third received subsequent anticholinergics in addition to α-blocker. Storage subscore was higher in patients with anticholinergics than those without it, but vice-versa for voiding subscore. Similar improvement on clinical outcomes and PROs was observed in all treatment groups.

Smoking and prevalence of nocturia in Japanese patients with type 2 diabetes mellitus: a post-hoc analysis of The Dogo Study.

AIMS: No evidence exists regarding the association between smoking status and nocturia among patients with type 2 diabetes mellitus. We evaluated this association among Japanese patients with type 2 diabetes mellitus by post-hoc analysis. METHODS: Study subjects were 817 Japanese patients with type 2 diabetes mellitus. Study subjects were considered to have nocturia if they answered "once or more" to the question: "Within one week, how many times do you typically wake up to urinate from sleeping at night until waking in the morning?" We used the following three outcomes: (1) nocturia was ≥1 voids per night; (2) moderate nocturia was ≥2 voids per night; and (3) severe nocturia was ≥3 voids per night. Adjustments were made for age, sex, body mass index, hypertension, dyslipidemia, stroke, glycated hemoglobin, current drinking, use of anti-hypertensive agent, use of insulin, use of oral anti-hyperglycemic agent, and diabetic retinopathy. RESULTS: The prevalence values of one void per night, two voids per night, and three or more voids per night were 39.5%, 27.1%, and 14.8%, respectively. Current smoking was independently inversely associated with severe nocturia compared with never or former smoking; the adjusted PR was 0.47 (95%CI: 0.25-0.89). Among the 443 patients who had ever smoked, compared with former smoking, current smoking was independently inversely related to severe nocturia; the adjusted PR was 0.44 (95%CI: 0.24-0.82). CONCLUSIONS: In Japanese patients with type 2 diabetes mellitus, current smoking may be independently inversely associated with severe nocturia.

Nocturnal Urinary Disorders and Multiple Sclerosis: Clinical and Urodynamic Study of 309 Patients.

PURPOSE: The aim of this study was to describe nocturia with or without leakage in a population of patients with multiple sclerosis. MATERIALS AND METHODS: This is a retrospective, single center study of 309 patients with multiple sclerosis who were followed at an experienced neurourology center between 2011 and 2013. All patients had daytime urinary symptoms associated with this disorder. Among the patients with nocturia 2 groups were defined, including those with isolated nocturia but without nocturnal urinary incontinence and patients with nocturia associated with nocturnal urinary incontinence. The control group comprised patients without nocturia. The clinical variables and urodynamic data studied were gender, age, EDSS (Expanded Disability Status Scale), the USP (Urinary Symptoms Profile) questionnaire overactive bladder score, bladder capacity, detrusor activity and volume at the first detrusor contraction. RESULTS: Of our patients 53.3% had nocturia, including 35.7% with nocturnal urinary incontinence. The average ± SD USP overactive bladder score was statistically greater in patients with nocturia than in controls (9.14 ± 4.3 vs 5.1 ± 3.5, p = 8.21E-17). Mean maximum cystometric capacity was statistically higher in the control group than in patients with nocturia (380.17 ± 113.79 vs 313 ± 128.4 ml, p = 5.60E-6). A similar outcome was found for the first contraction (mean 232.58 ± 146.05 vs 181.14 ± 100.11 ml, p = 0.041). CONCLUSION: Isolated nocturia or nocturnal urinary incontinence is a frequent problem encountered with multiple sclerosis. Our results suggest that an overactive detrusor is the main mechanism. Further studies are needed to verify the complications arising from nocturia.

Systematic Review and Meta-Analysis of Intravesical Hyaluronic Acid and Hyaluronic Acid/Chondroitin Sulfate Instillation for Interstitial Cystitis/Painful Bladder Syndrome.

BACKGROUND/AIMS: To assess the efficacy of intravesical hyaluronic acid (HA) and HA/chondroitin sulfate (CS) instillation in patients with interstitial cystitis/painful bladder syndrome by systematic review and meta-analysis. METHODS: A systematic literature search was performed using the keywords: 'interstitial cystitis' or 'painful bladder syndrome' or 'bladder pain syndrome' and 'hyaluronic acid', up to March 31, 2016. The primary outcome was visual analogue scale related pain symptom (VAS). Secondary outcomes were the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), frequency, nocturia, bladder volume, and voided urine volume. RESULTS: Ten articles involving 390 patients were retrieved and assessed in analysis. A significant improvement in mean VAS on fixed-effect and random-effect models (mean difference [MD] -3.654, 95% confidence interval [CI] -3.814 to -3.495, and MD -3.206, 95% CI -4.156 to -2.257, respectively) was found. Significant improvements were found in the ICSI (MD -3.223, 95% CI -4.132 to -2.315) and ICPI (MD -2.941, 95% CI -3.767 to -2.116). Similarly, the other outcomes were significantly improved. CONCLUSION: Intravesical HA and HA/CS instillation improved pain symptom, quality of life, and other outcomes and could be included as therapeutic modality of interstitial cystitis/painful bladder syndrome.

Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men.

OBJECTIVES: To examine the influence of obstructive sleep apnea (OSA) on nocturia, controlling for their shared co-morbidities, in a population of community-based middle aged to elderly men. METHODS: Participants were drawn from a randomly selected, community-dwelling cohort of men in Adelaide, Australia. Seven hundred and eight men (mean: 60.7 [41.6-88.2] years) who had polysomnography recordings, complete lower urinary tract symptoms (LUTS) measures (International Prostate Symptom Score), without prostate or bladder cancer and/or surgery, and no prior OSA diagnosis were selected. Nocturia was defined as ≥2 voids per main sleep. Unadjusted and multi-adjusted regression models of nocturia were combined with OSA, wake after sleep onset, total sleep period, excessive daytime sleepiness (EDS), and sleep quality (SQ) data, together with socio-demographic, and health-related factors. RESULTS: Men with nocturia were found to have higher levels of OSA (32.2% [n = 65]), wake after sleep onset time (97.2 ± 52.9 minutes), sleep period (467.3 ± 58.4 minutes), EDS (18.2% [n = 37]), and poorer SQ (54.3% [n = 108]). Multiple-adjusted models showed nocturia was positively associated with OSA (odds ratio:1.64, 95% confidence interval [1.03,2.55]), EDS (1.72 [1.01,2.93]), and poorer SQ (1.65 [1.10,2.48]). Including other storage and voiding LUTS attenuated the effect of OSA and strengthened the association with EDS (2.44 [1.45,4.10] and 2.24 [1.19,4.22]), whereas voiding LUTS also strengthened the association with poorer SQ (2.61 [1.63,4.17]). Men with increasing nocturic frequency spent less time in N2 and rapid eye movement stage sleep. CONCLUSION: Nocturia is strongly associated with OSA in community-based men. Nocturia also reduces sleep efficiency/SQ, N2, and rapid eye movement sleep time, while increasing EDS. Other LUTS increase EDS through non-OSA means.

Independent Associations Between Nocturia and Nighttime Blood Pressure/Dipping in Elderly Individuals: The HEIJO-KYO Cohort.

OBJECTIVES: To evaluate the association between nocturnal void frequency and ambulatory blood pressure (BP). DESIGN: Cross-sectional. SETTING: Nara, Japan. PARTICIPANTS: Community-based elderly individuals (mean age 72.1, N = 867). MEASUREMENTS: Nocturnal void frequency and ambulatory BP. RESULTS: Two hundred twenty-four participants had no nocturnal void, 384 had one nocturnal void, and 259 had two or more nocturnal voids. Univariate comparisons showed that more-frequent nocturnal voiding was significantly associated with higher nighttime systolic BP (SBP) and lower dipping (nocturnal voids: ≥2, nighttime SBP 121.1 mmHg, dipping 11.8% vs 0, nighttime SBP 111.5 mmHg, dipping 15.8%, P < .001). Multivariate models revealed that two or more nocturnal voids was significantly associated with higher nighttime SBP and lower dipping than no nocturnal voids (adjusted mean difference for nighttime SBP (nocturnal voids ≥2 minus 0): 6.3 mmHg, 95% confidence interval (CI) = 2.6 to 10.1 mmHg, P < .001; adjusted mean difference for dipping (nocturnal voids ≥2 minus 0): -2.8%, 95% CI = -4.9% to -0.7%, P = .005) and that the associations were independent of potential confounding factors such as age, sex, body mass index, smoking status, antihypertensive use, diabetes mellitus, renal function, asymmetric dimethylarginine, bedtime, length of time in bed, daytime and nighttime physical activity, endogenous melatonin levels, and bedroom light levels. In contrast, one void per night was not significantly associated with nighttime SBP and dipping. CONCLUSION: Nocturia is significantly associated with nighttime SBP and dipping in the general elderly population, independent of several confounding factors such as age, sex, metabolic abnormalities, physical activity, and circadian rhythm parameters.

Impact of transobturator tape treatment on overactive bladder symptoms, particularly nocturia, in patients with mixed urinary incontinence.

PURPOSE: We assessed the impact of transobturator tape (TOT) treatment on overactive bladder (OAB) symptoms with a particular focus on nocturia in patients with mixed urinary incontinence (MUI). MATERIALS AND METHODS: In this retrospective cohort study, the medical records of 237 women who underwent TOT surgery for the treatment of MUI were reviewed. Of these, 86 patients (36.4%) had preoperative nocturia. Patients with neurological diseases or sleep disorders that could affect the voiding pattern were excluded. Patients who were being treated with anticholinergics and antidiuretic hormones were also excluded, which left 70 subjects eligible for analysis. Pre- and postoperative evaluations consisted of a physical examination, 3-day frequency-volume chart, and health-related quality of life questionnaires (King's health questionnaire, overactive bladder symptom score, and OAB-questionnaire). RESULTS: TOT treatment resulted in an overall significant improvement in OAB symptoms including nocturia. Frequency-volume charts revealed that TOT treatment significantly decreased the actual number of nightly voids (ANV) and the nocturnal bladder capacity index (NBCi) in the entire cohort. However, in a subgroup of women with nocturnal polyuria, there was no significant change in ANV or NBCi after the sling operation. Correlation analysis of the whole cohort revealed that the postoperative changes in NBCi correlated positively with postoperative changes in ANV. The nocturia-persisting group was more likely to have nocturnal polyuria and lower preoperative functional bladder capacity compared with the nocturia-improved group (p=0.024 and p=0.023, respectively). CONCLUSIONS: Our results demonstrated that the TOT procedure resulted in an overall significant improvement in OAB symptoms including OAB-related nocturia in patients who presented with MUI.

Is there seasonal variation in symptom severity, uroflowmetry and frequency-volume chart parameters in men with lower urinary tract symptoms?

PURPOSE: There is a widely held perception that lower urinary tract symptoms may be exacerbated by cold weather. In this study, we examine the effect of seasonal variation in ambient temperatures on frequency-volume chart derivatives, symptom severity scores and uroflowmetry parameters in men with lower urinary tract symptom. METHODS: Between January 2000 and April 2004, men presenting with lower urinary tract symptom were prospectively recruited and assessed in Edinburgh, UK (55°52'N) with maritime temperate climates (Köppen classification Cfb). Local monthly temperatures were extracted from national meteorological records. Patients completed the International Prostate Symptom Score and 3-day frequency volume chart before undergoing free uroflowmetry with post-micturition volume measurement. Exclusion criteria were previous bladder outflow surgery and anti-cholinergic medication. RESULTS: Data on 296 patients were suitable for analysis. Mean age was 62.3 years (range, 26-90). Over the period of study, the coldest month was January (mean = 4.7℃) and the warmest month was August (mean = 15.8℃). There was no significant variation in either International Prostate Symptom Score symptom scores by season (p > 0.05) or any frequency-volume chart parameters, with the exception on an increase in median actual nightly voids over the summer months (p = 0.021). There was no significant correlation between maximal flow rate and post-micturition residual volumes and mean monthly temperatures (p > 0.05). CONCLUSIONS: Seasonal variation in nocturia, but not other frequency-volume parameters, symptom severity or uroflowmetry parameters, is significant in men with lower urinary tract symptom. Future work should consider the impact of seasonal variation in lower urinary tract symptoms in both sexes across a wider range of climates.

Clinical and video urodynamic characteristics of adult women with dysfunctional voiding.

BACKGROUND/PURPOSE: Dysfunctional voiding (DV) is an abnormality of bladder emptying in neurologically normal individuals where the external sphincter activity increases during voiding. This study investigated the clinical presentations and videourodynamic characteristics of adult women with DV. METHODS: A total of 1605 women with lower urinary tract symptoms (LUTS) were investigated with videourodynamic (VUD) studies from 1997 to 2010. The clinical urinary symptoms and VUD characteristics of DV were compared with a group of urodynamically normal controls. Antimuscarinic or alpha-blocker treatment according to the chief complaint of storage or voiding LUTS was respectively given. RESULTS: There were 168 women diagnosed with DV. Detrusor overactivity (DO) occurred in 69% of women with DV. Patients with DV had significantly lower cystometric bladder capacity, higher detrusor pressure, lower maximum flow rate, and larger post-void residual volume than the controls. A total of 114 (67.9%) patients had storage symptoms and 54 (32.1%) had voiding symptoms as their chief complaints among those with DV. Among them, urinary frequency (n = 69, 41.1%) was the most common chief complaint, followed by dysuria (n = 53, 32.1%), and urgency incontinence (n = 26, 15.5%). The incidence of urgency incontinence and dysuria were significantly greater than that in the control group, however, the incidence of frequency, urgency, or nocturia showed no significant difference between DV and control groups. The success rates were 41.2% (n = 47) for antimuscarinic therapy and 51.9% (n = 28) for alpha-blocker therapy in patients with storage and voiding LUTS, respectively (p = 0.366). CONCLUSION: DO and storage LUTS commonly occurred in women with DV, suggesting DO could be one of the etiology in the pathophysiology of DV. VUD studies yielded a high diagnostic rate for DV in women with LUTS.