Female pelvic floor myofascial syndrome and its relationship with lower urinary tract storage symptoms

Background: Pelvic floor myofascial syndrome is defined as non-articular skeletal muscle pain, characterized by the presence of trigger points. Present in 14-23% of patients with chronic pelvic pain. It has an impact on urinary function. The prevalence of lower urinary tract symptoms is 15-67%, with storage symptoms predominating in patients with PFMS. Objective was to determine the relationship between female pelvic floor myofascial syndrome and lower urinary tract storage symptoms.Methods: This was a retrospective, observational, descriptive, cross-sectional, homodemic and single-center study at University Hospital Doctor José Eleuterio González, Monterrey, Nuevo Leon, Mexico from period one from April 1st to June 30th, 2022. Type of non-probabilistic convenience sampling. Database in Excel 2016, Pearson's ?² statistical test in the SPSS V25® program.Results: 136 patients with PFMS and LUTS storage were evaluated. The most frequent age group was 46-55 years with 33.1% (N=45); the marital status was married with 74.3% (N=101). In relation to education 55.9% (N=76) with a bachelor's degree. The most frequent storage symptoms were nocturia 67.6% (N=92) p<0.05, frequency 60.3% (N=82) p=0.512, urgency 57.4% p<0.005.Conclusions: Knowing the correlation between PFMS and storage LUTS can guide specific pain treatment with review of urinary symptoms. In patients with nocturia, frequency, urgency, SUI and UUI, a physical examination should be performed and included trigger points in the pelvic floor. Nocturia is the most prevalent storage LUTS in PFMS.

Urinary symptoms, falls and fear of falling in older people with cognitive impairment / Sintomas urinários, quedas e medo de cair em idosos com comprometimento cognitivo

Abstract Introduction: Among geriatric syndromes, cognitive impairment, urinary incontinence, nocturia, and falls stand out. Older adults with urinary incontinence are more prone to falls and exhibit fear of falling. Objective: To investigate the frequency of urinary incontinence and nocturia and evaluate the association of these variables with falls and fear of falling in older individuals with cognitive impairment. Methods: Cross-sectional study with older adults referred from Basic Health Units with cognitive impairment evaluated between 2019 and 2021. Information on urinary incontinence, nocturia, history of falls, and fear of falling provided by the participants and their caregivers was collected. Data were analyzed using Chi-square tests and univariate logistic regressions. Results: Data from 89 older adults were analyzed, of whom 58.4% had urinary incontinence, 28.1% had nocturia, 67.4% reported fear of falling, and 41.6% reported falls in the last six months. The group with urinary incontinence [χ2(1) = 5.147; p = 0.023] and the group with nocturia [χ2(1) = 4.353; p = 0.037] had significantly higher frequencies of fear of falling. No differences in the frequencies of history of falls were observed between individuals with and without urinary incontinence or nocturia (p > 0.05). Fear of falling was associated with urinary incontinence (OR = 2.833; 95% CI 1.137 - 7.062) and nocturia (OR = 3.365; 95% CI 1.033 - 10.966). Conclusion: Older adults with cognitive impairment have a high frequency of urinary incontinence, nocturia, falls, and fear of falling. Furthermore, there is an association between urinary incontinence, nocturia and fear of falling in this population.

Resumo Introdução: Entre as síndromes geriátricas, destacam-se o comprometimento cognitivo, a incontinência urinária, a noctúria e as quedas. Idosos com incontinência urinária são mais propensos a cair e apresentar medo de cair. Objetivo: Investigar a frequência de incontinência urinária e noctúria e avaliar a associação dessas variáveis com a ocorrência de quedas e com o medo de cair em idosos com comprometimento cognitivo. Métodos: Estudo transversal com idosos encaminhados das Unidades Básicas de Saúde com comprometimento cognitivo avaliados entre os anos de 2019 e 2021. Foram coletadas informações sobre incontinência urinária, noctúria, histórico de quedas e medo de cair, fornecidas pelos idosos e seus acompanhantes. Os dados foram analisados por meio dos testes quiquadrado e regressões logísticas univariadas. Resultados: Foram analisados dados de 89 idosos, dos quais 58,4% apresentavam incontinência urinária, 28,1% apresentavam noctúria, 67,4% tinham medo de cair e 41,6% relataram quedas nos últimos seis meses. O grupo com incontinência urinária [2(1) = 5,147; p = 0,023] e o grupo com noctúria [χ2(1) = 4,353; p = 0,037] apresentaram frequências significativamente maiores de medo de cair. Não foram observadas diferenças das frequências de histórico de quedas entre os indivíduos com e sem incontinência ou noctúria (p > 0,05). O medo de cair mostrouse associado à incontinência (OR = 2,833; IC95% 1,137 - 7,062) e à noctúria (OR = 3,365; IC 95% 1,033 - 10,966). Conclusão: Idosos com comprometimento cognitivo apresentam alta frequência de incontinência urinária, noctúria, quedas e medo de cair. Ademais, há associação da incontinência urinária e da noctúria com o medo de cair nessa população.

Prevalência de noctúria e fatores associados em mulheres atendidas em dois ambulatórios de uroginecologia no estado do Rio de Janeiro: um estudo transversal / Prevalence of nocturia and associated factors in women attending two urogynecology outpatient clinics in the state of Rio de Janeiro: a cross-sectional study

Resumo Objetivo Identificar a prevalência e fatores relacionados à noctúria em mulheres que apresentam sintomas do trato urinário inferior. Métodos Inquérito observacional transversal, individuado, de base hospitalar, envolvendo mulheres atendidas pelo Sistema Único de Saúde em ambulatórios de uroginecologia em Niterói e Petrópolis, RJ, Brasil. Foram coletados dados sociodemográficos, clínicos e hábitos de vida. Foram considerados dois desfechos de noctúria: uma ou mais micções e duas ou mais micções, o segundo devido ao maior impacto na qualidade de vida. As associações entre as variáveis investigadas e os desfechos foram avaliadas por modelo de regressão logística, e obtidas razões de chances brutas e ajustadas. Resultados Foram incluídas 132 participantes. A prevalência de noctúria foi 71,2% e, de duas ou mais micções, 56,8%. Houve associação de menor escolaridade (OR: 0,260 [0,106;0,637], p=0,003), incontinência urinária mista (OR: 2,533 [1,103;5,817], p=0,028) e três ou mais comorbidades (OR: 3,105 [1,340;7,196], p=0,008) com maior chance de noctúria. Menor escolaridade (OR: 0,324 [0,148;0,709], p=0,005), menor consumo de cafeína (OR: 0,995 [0,990;1,000], p=0,041) e síndrome da bexiga hiperativa (OR: 2,761 [1,189;6,409], p=0,018) mostraram-se associadas a uma maior chance de duas ou mais micções. Conclusões Na população atendida em serviços especializados, a prevalência de noctúria foi semelhante à da população em geral e à de serviços semelhantes, mas a prevalência de duas ou mais micções foi superior. Mostrou-se importante a busca ativa de noctúria em mulheres com comorbidades, em especial três ou mais, e a adequada compensação das mesmas no manejo do sintoma.

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

Preliminary results of a trial on Mirabegron in combination with microecologics for the treatment of overactive bladder in elderly women / 中华老年医学杂志

Objective:To investigate the efficacy of Mirabegron plus microecologics for the treatment of overactive bladder(OAB)in elderly women.Methods:In this prospective study, 104 patients diagnosed with OAB in the urology department of our hospital between February 2020 and December 2021 were recruited.The participants were randomly divided into two groups, with 52 in each.Group I was treated with Mirabegron alone(50 mg, qd)and Group Ⅱ was treated with Mirabegron(50 mg, qd)plus probiotics(3.5 g, bid)for 12 weeks.The efficacy was evaluated based on results before and after treatment, using measurements including the daily frequencies of urinary urgency, nocturia, daytime urination, urge incontinence and bladder capacity.The overactive bladder symptom score(OABSS), the quality-of-life score, and the number of lower urinary tract infections during treatment were also collected.Results at different treatment stages(week 4 and week 12)were compared within each group and between the two groups by Dunnett's test.Results:The symptoms of OAB in both groups were significantly improved after 12 weeks' treatment.In the group(Group Ⅱ)receiving the combination of two drugs, results from four measurements, the frequency of 24-hour urination(6.6 ± 0.7 vs.7.1 ± 1.2), the frequency of 24-hour urinary urgency(0.6 ± 0.6 vs.1.1 ± 0.7), the frequency of daily nocturia(0.8 ± 0.7 vs.1.3 ± 0.6)and the quality-of-life score(1.2 ± 0.7 vs.2.3 ± 0.8), were all significantly more favorable than in the group(Group I)treated with Mirabegron( P<0.05).The incidence of lower urinary tract infections and constipation was significantly reduced in the group with drug combination treatment. Conclusions:The efficacy of Mirabegron combined with microecologics for the treatment of OAB is better than that of Mirabegron alone, and the incidence of adverse events such as infections and constipation is also lower.

The clinical features of nocturnal enuresis in adult men and women / 中华泌尿外科杂志

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

Continuous Positive Airway Pressure-induced Improvement in Arousal and Nocturia in Patients with Stroke：A Case Report / The Japanese Journal of Rehabilitation Medicine

Sleep apnea syndrome (SAS) is a known risk factor for cerebral stroke and other cardiovascular diseases；approximately 50% of patients with cerebral stroke subsequently develop sleep-related breathing disorders. Obstructive SAS (OSAS) is the most common form of SAS. Concomitant SAS is considered a poor prognostic factor in patients who undergo cerebral stroke rehabilitation；however, many patients remain undiagnosed. We report the case of a 69-year-old woman who was admitted to the convalescent rehabilitation ward with a diagnosis of cerebral hemorrhage. Results of the STOP-Bang questionnaire administered upon admission revealed that the patient was at a high risk for SAS, and she was subsequently diagnosed with OSAS based on simple respiratory function tests. Nighttime continuous positive airway pressure (CPAP) therapy led to improvement in the patient's daytime awakening and nocturnal frequency, and her rehabilitation treatment became easier. In addition to obstruction of the upper airway, nocturnal rostral fluid shift is implicated in the pathophysiology of OSAS-induced nocturia (polyuria), and the combination of exercise and CPAP therapy may serve as a useful treatment strategy in such cases.

Prevalence and associated factors in community-dwelling subjects - a population-based study

SUMMARY OBJECTIVES To assess the prevalence of nocturia and identify factors associated with it in a community-dwelling population. METHODS A cross-sectional study was conducted in subjects aged 45 years or more and registered with a Family Doctor Program. Information was collected about nocturia, other urinary symptoms, physical examination, co-morbidities, demographics, socio-economic, and lifestyle factors. Multiple logistics regression models were developed to analyze associated factors for nocturia according to gender and the number of nocturnal micturitions(≥1 and ≥2). RESULTS Out of the 661 individuals included in the study, 62.3% were women. Among the women, the prevalence rates for nocturia ≥1 time and ≥2 times were, respectively, 68.4% and 49%, whereas, among the men, they were 64.3% and 43.8%. Among the women, nocturia ≥1 time was associated with brown skin, a higher BMI, lower schooling, and calcium channel blockers(CCB) use, while nocturia ≥2 times showed association with higher BMI, lower schooling, obstructive sleep apnea (OSA), and the use of CCB. Among the men, nocturia ≥1 time was associated positively with age, alcohol intake, and OSA, and negatively with angiotensin receptor blockers and beta-blockers use. Besides, nocturia ≥2 times was associated with age, not having health insurance, and OSA. CONCLUSIONS Nocturia is a condition highly prevalent in the studied population. For the female subjects, a higher BMI, lower schooling, and the use of CCB were associated with nocturia regardless of the definition used, whereas, among the men, that same association was found with age, not having health insurance, and OSA.

RESUMO OBJETIVOS Estimar a prevalência de noctúria e identificar fatores demográficos, socioeconômicos, clínicos e de estilo de vida associados ao sintoma em uma população comunitária. MÉTODO Estudo transversal em indivíduos com 45 anos ou mais. Foram obtidas informações demográficas, socioeconômicas, sobre noctúria, outros sintomas urinários, exame físico, comorbidades e estilo de vida. As análises foram feitas separadamente de acordo com o gênero e com o número de micções noturnas (≥1 vez e ≥2 vezes). RESULTADOS Dentre os 661 indivíduos incluídos, 62,3% eram mulheres. Entre elas, a prevalência de noctúria ≥1 vez e ≥2 vezes foi, respectivamente, de 68,4% e 49%, enquanto entre os homens foi de 64,3% e 43,8%. Entre as mulheres, a noctúria ≥1 mostrou associação com cor da pele parda, maior IMC, baixa escolaridade e uso de bloqueadores dos canais de cálcio (BCC), enquanto noctúria ≥2 vezes mostrou associação com maior IMC, baixa escolaridade, apneia obstrutiva do sono (AOS) e uso de BCC. Entre os homens, a noctúria ≥1 vez esteve associada positivamente com idade, ingestão de álcool e AOS, e negativamente com uso de bloqueadores dos receptores da angiotensina e de beta-bloqueadores. Além disso, noctúria ≥2 vezes associou-se a idade, não ter plano de saúde e AOS. CONCLUSÕES A noctúria é uma condição altamente prevalente na população estudada. Para as mulheres, IMC elevado, baixa escolaridade e uso de BCC estiveram associados com noctúria independente da definição, enquanto que, para os homens, a mesma associação foi identificada com idade, não ter plano de saúde e AOS.

Association between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure: a single-center cross-sectional study

ABSTRACT BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.

A Prospective, Multicenter, Open-Label Study of Dose Escalation Therapy in Male Patients With Nocturia Refractory to 0.2-mg Tamsulosin Monotherapy / 대한배뇨장애요실금학회지

PURPOSE: To investigate the efficacy and safety of 0.4 mg of tamsulosin in patients with nocturia not responding to 0.2 mg.METHODS: Patients with intractable nocturia after treatment with 0.2 mg of tamsulosin for>1 month were included in a multicenter, prospective, observational, single-arm study. Patients were prescribed 0.4 mg of tamsulosin and followed up for 2 months to assess nocturnal voiding and nocturia-related bother. Changes in the mean number of nocturnal voids, the proportion of 50% responders, 3-day frequency-volume chart parameters, and questionnaire scores were assessed.RESULTS: Sixty-two patients were prescribed 0.2 mg of tamsulosin, of whom 56 were prescribed 0.4 mg of tamsulosin. Ten patients dropped out. A single case of orthostatic hypotension was reported. The mean age was 68 years. After 1 and 2 months of taking 0.4 mg of tamsulosin, 23.9% and 22.7% of patients demonstrated a>50% reduction of nocturia, and 16.1% and 19.4% of patients rated the treatment as “very effective,” respectively. Dose escalation to 0.4 mg of tamsulosin, compared to 0.2 mg, did not show an additional effect on reducing nocturnal urine volume. Multivariate logistic regression analysis showed that lower serum sodium levels (odds ratio [OR], 0.41, P=0.037) and the presence of urge incontinence (OR, 7.08, P=0.036) were predictors of a significant improvement of nocturia in response to 0.4 mg of tamsulosin.CONCLUSIONS: Dose escalation may yield a significant improvement of nocturia in>20% of patients, and may be especially helpful in patients with lower sodium levels and urge incontinence.

Influence of Circadian Disruption Associated With Artificial Light at Night on Micturition Patterns in Shift Workers / 대한배뇨장애요실금학회지

Shift workers often experience problems associated with circadian disruption associated with artificial light at night and nocturia is commonly noted in night-shift workers. Nocturia associated with circadian disruption is due to increased urine production of the kidney and decreased storage function of the bladder. A recent discovery of peripheral clock genes in the bladder and their role in contractile property of the bladder support that micturition is closely related to the circadian rhythm. Moreover, there are clinical studies showed that shift workers more often experienced nocturia due to circadian disruption. However, comparing with other health problems, concerns on nocturia and voiding dysfunction associated with circadian disruption are insufficient. Therefore, further studies about voiding dysfunction associated with the circadian disruption in shift workers are necessary.

Prevalence of lower urinary tract symptoms and associated distress among female college students in Xuzhou / 中国学校卫生

Objective@#To explore the prevalence and associated distress of lower urinary tract symptoms among female college students in Xuzhou.@*Methods@#Convenience sampling was used to recruit 1 000 female college students in Xuzhou China. Chinese versions of International Consultation on Incontinence Questionnaire LUTS and General Information Questionnaire was used.@*Results@#The prevalence of lower urinary tract symptoms was 95.7%. The top ten prevalence rates were urgency (88.2%), hesitancy (65.4%), nocturia (48.5%), intermittent stream (47.3%), straining (30.5%), increased daytime frequency (30.1%), bladder pain (21.0%), SUI (18.5%), UUI (13.9%), nocturnal enuresis (7.5%). Urinary urgency was the most disturbing symptom (49.0%). Risk factors of urinary urgency included rural household registration (OR=1.67, 95%CI:1.10-2.55, P=0.017) and premature urination (OR=1.65, 95%CI:1.23-2.21, P=0.00).@*Conclusion@#Female college students have a high prevalence of lower urinary tract symptoms but with moderate severity and distress. Toileting behaviors affect bladder health, which require early intervention.

The Association Between Obesity and the Nocturia in the U.S. Population / 대한배뇨장애요실금학회지

PURPOSE: We aimed to investigate the association of obesity with nocturia using a nationally representative sample of adults from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2012. METHODS: A total of 14,135 participants were included in this study. We performed a multivariate logistic regression analysis to find the odds ratio (OR) of obesity for nocturia. Furthermore, the OR of BMI for nocturia was analyzed using restricted cubic splines (RCS) with five knots. We conducted subgroup analysis according to age, sex, hypertension, and diabetes mellitus (DM) and further analysis with 1:1 matching data with propensity score. RESULTS: The participants who had body mass index (BMI) above 30 kg/m² had a significantly higher OR for nocturia (OR, 1.39; 95% CI, 1.28–1.50) than those without obesity. RCS showed a dose-dependent relationship between BMI and OR for nocturia. Subgroup analysis by age, sex, hypertension, and DM showed similar results. Further analysis with 1:1 matching data showed a significant association of obesity with the prevalence of nocturia (OR, 1.25; 95% CI, 1.10–1.41). CONCLUSIONS: This study reported that obesity was significant association with the prevalence of nocturia with dose-dependent manner, regardless of age, sex, hypertension, and DM after taking major confounding factors into account.

Effect of Nocturnal Hypoxia on Nocturia in Patients With Obstructive Sleep Apnea / 대한배뇨장애요실금학회지

PURPOSE: To identify the association between nocturia and obstructive sleep apnea (OSA), we compared results of polysomnography (PSG) with the presence or absence of nocturia in patients with suspected OSA. METHODS: Patients underwent PSG for suspected OSA. The International Prostate Symptom Score and quality of life (IPSS/QoL) questionnaire was evaluated to assess voiding symptoms that may affect sleep quality. The results of PSG were compared between patient groups with or without nocturia. RESULTS: In logistic regression analysis, age (odds ratio [OR], 1.052; P=0.004), diabetes mellitus (OR, 6.675; P<0.001), mean O₂ saturation (OR, 0.650; P=0.017), oxygen desaturation index (ODI) 3 (OR, 1.193; P=0.010), and ODI4 (OR, 1.136; P=0.014) affected nocturia independently among the OSA-suspected patients. CONCLUSIONS: Hypoxia caused by OSA affects the incidence of nocturia. Less desaturated OSA patients with nocturia may require more urological evaluation and treatment for nocturia even after the correction of OSA.

Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome

ABSTRACT Objective The main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in patients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thickness (BWT) in these patients. Materials and Methods The patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evaluated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated. Results The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO2) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO2) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002). Conclusion The results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measurements between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

Effect of Gosyajinkigan for Nocturia / 日本東洋医学雑誌

We evaluated the effect of gosyajinkigan in 30 cases of anticholinergic agent or α-1 blockers resistant nocturia with a sign of jinkyo which is the hypofunction of the kidney organ unit at Kampo medicine. As to subjective outcomes, storage symptoms and quality of life (QOL) of International Prostate Symptom Score, and sleep and energy items of King's Health Questionnaire and Nocturia QOL Questionnaire were statistically much improved. Concerning objective outcomes, nocturnal frequency of urination, nocturnal polyuria index and hours of undisturbed sleep by means of frequency volume chart, and total body water by body composition analyser were also statistically much improved. This study might demonstrate that normalization of body composition leads to reduce nocturnal urinary volume and improve nocturia.

Sex Differences in Lower Urinary Tract Symptoms in Older Korean Adults Living in Rural Areas: Prevalence, Quality of Life, and Associated Factors / 대한배뇨장애요실금학회지

PURPOSE: Urinary incontinence (UI) is associated with nursing home admission, functional decline, and risk of death among community-dwelling older adults. Little information, however, is available on sex differences in lower urinary tract symptoms (LUTS) in older Korean adults exclusively living in rural areas. This study examined sex-related differences in LUTS, factors associated with UI in older adults living in rural areas, and health-related quality of life (HRQoL) in incontinent older adults. METHODS: This was a cross-sectional study in which face-to-face interviews were conducted at 15 rural community-health centres. A total of 323 older adults aged ≥65 years from rural areas of Korea participated. LUTS prevalence was evaluated and HRQoL was measured using the King’s Health Questionnaire. The chi-square test and t -test were used to examine sex differences in characteristics, LUTS, and HRQoL. Multivariable logistic regression was used to identify risk factors associated with UI. RESULTS: Nocturia was the most prevalent symptom, affecting 87% of men and 86% of women. Women (53%) had significantly more UI of any kind than did men (35%) (P=0.007). Urgency UI was the most frequent type of UI in men, whereas stress UI was the most frequent in women. Regarding HRQoL, men had significantly higher scores in the domains of sleep/energy disturbances (P=0.032) than did women, and women reported greater effects from the severity of incontinence (P=0.001) than did men. Arthritis was the only factor associated with UI in men (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.46–32.36). However, women with diabetes mellitus were less likely to have UI than those without (OR, 0.43; 95% CI, 0.23–0.82). CONCLUSIONS: LUTS were found to be highly prevalent in community-dwelling older Korean adults in rural areas. Interventions to improve sleep and to reduce UI severity are needed for incontinent men and women, respectively.

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

PURPOSE: The purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia. MATERIALS AND METHODS: In 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. RESULTS: A 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. CONCLUSIONS: Regardless 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.

Effects and safeties of desmopressin on nocturia in medium-elderly men / 中华泌尿外科杂志

Objective To explore the effects and safeties of desmopressin on nocturia in elderly men.Methods We used random number table to divide patients into 2 groups.The patient in treatment group took desmopressin acetate tablets 0.2 mg orally and the patient in control group took tamsulosin hydmchloride sustained release capsule 0.2 mg orally before sleep for 4 weeks.The patient recorded 24 hours voiding diaries for 3 days and worked out mean number of nocturnal voids,hours of undisturbed sleep (HUS) before treatment and before subsequent visit weekly.Before treatment and 1 to 4 weeks after treatment,mean number of nocturnal voids,HUS,night quality of life (NQOL),quality of life (QOL),adverse event were recorded.Before treatment,1 week and 4 weeks after treatment,blood serum sodium was checked in treatment group.Results 42 men had been diagnosed with nocturia in outpatient department of investigator from December 2014 to March 2016,34 of them were recruited in our study and randomly enter the treatment group or control group.Each group consisted of 17 cases.There was no statistical difference in the baseline data between two groups (all P ＞ 0.05).The average ages of treatment group and the control group were (65.1 ± 11.2) and (63.9 ± 9.3) years old,the courses of disease were (3.0 ± 5.0) and (2.3 ± 2.6) years,respectively.Before treatment mean numbers of nocturnal voids were (3.8 ± 1.2) and (3.2 ± 1.4) times,HUS were (1.8 ± 1.7) and (1.8 ± 0.6) h,NQOL were (51.8 ± 13.8) and (41.2 ± 13.6),QOL were (4.0 ± 1.0) and (3.9 ± 0.9),respectively.Four weeks after treatment,mean numbers of nocturnal voids decreased to (1.6 ± 1.0) and (2.0 ± 0.9) times,HUS increased to (4.0 ± 0.7) and (2.6 ± 0.7) h,NQOL decreased to (20.9 ± 12.0) and (30.6 ± 12.4),QOL decreased to (1.4 ± 1.1) and (2.9 ± 1.0) in treatment group and control group,respectively.Every index of the two groups were statistically significant differences compared with that before treatment (P ＜ 0.05).There were statistically significant differences in the degree of improvement between treatment group and control group from 2 weeks to 4 weeks after treatment (P ＜ 0.05).Therefore,the degree of improvement of treatment group was superiored to the control group.Before treatment and both 1 week and 4 weeks after treatment,the blood serum sodium of patients in treatment group were (140.3 ± 3.9),(139.2 ± 4.3) and (140.6 ± 3.1) mmol/ L,respectively.Two patients of treatment group appeared dizzy during the follow-up period.In one of both,the symptom disappeared after the dose decreased from 0.2 mg to 0.1 mg per night.The symptom sustained and the dose was not changed in the other one.In treatment group,two other patients suffered from dyspepsia,one palpitation and one thirst.Those symptoms could be tolerated and the dose was not changed.In control group,2 patients suffered from thirst,one nasal congestion,one dizzy and one short of breath.All of those symptoms could be tolerated and the dose was not changed.There was not statistical differencebetween the occurrence rate of adverse events in the 2 groups (P =0.714).Conclusions Desmopressin can improve the symptoms of nocturia in elderly men,improve the quality of life of patients,and has goodsafety.

Influence of Daytime or Nighttime Dosing with Solifenacin for Overactive Bladder with Nocturia: Impact on Nocturia and Sleep Quality

We compared changes in nocturia and sleep-related parameters between daytime and nighttime solifenacin dosing in patents with overactive bladder (OAB) and nocturia. We comparatively analyzed the data of a 12-week prospective, open-label, multicenter, randomized study. All 127 patients who presented to 5 centers in Korea for the treatment of OAB with nocturia between January 2011 and December 2013 were enrolled in this study. The patients were divided into 2 groups by medication timing: group 1, daytime (n = 62); and group 2, nighttime (n = 65). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale (AIS) were used to assess OAB symptoms and sleep quality. We evaluated the parameter changes before and 12 weeks after daytime or nighttime solifenacin administration. Baseline data, which included sex, age, body mass index (BMI), total AIS, IPSS, and OABSS, did not differ between the 2 groups. Total IPSS, OABSS, and total AIS significantly improved after solifenacin administration regardless of timing (P < 0.001). After solifenacin administration, the number of nocturia episodes decreased in the group 1 and 2 (P < 0.001). There were no significant intergroup differences in changes in AIS, IPSS, OABSS, and number of nocturia episodes 12 weeks after solifenacin administration. Treating OAB with solifenacin may improve nocturia and sleep quality, but advantages did not differ significantly by medication timing.