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

OBJECTIVE: Postmenopausal 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. A total of 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 736 ml) versus less often (517 ml). Significant predictors of self-reported disruptive nocturia were age (odds ratio [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 with less frequent nocturia (P < 0.002). Exercise for 150 minutes a 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 versus less often (night: 268 ml versus 350 ml; day: 200 ml versus 290 ml). CONCLUSIONS: Bothersome nocturia in postmenopausal 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.

Acupuncture as a treatment for nocturnal enuresis.

Acupuncture can influence spinal micturition centers and parasympathetic innervation to the urinary tract and is known to modulate brain function via the descending serotonergic system. There are numerous difficulties in evaluating the efficacy of acupuncture in patients with nocturnal enuresis (NE), since the patient group is frequently heterogenous and the intervention is commonly given in association with other modalities. Until recently incomplete reporting of the quality aspects of studies has also limited evaluation of treatment effects. The aim of this study was to systematically evaluate reports from both Western and Eastern medicines in which acupuncture was compared to some other treatment modality in children with nocturnal enuresis. Focusing on Chinese language sources 41 new studies of acupuncture for NE were identified, 13 of which were clinical trials that reported parameters of treatment and defined outcome measures of efficacy. A standardized data extraction form was used to evaluate outcome measures and to scrutinize the quality aspects of studies. All barr one study reported the efficacy rate of acupuncture as part of a TCM package to be higher than alarm therapy, the gold standard of Western medicine intervention for NE. Acupuncture as a monotherapy for the treatment of NE appears to be less effective than acupuncture given as part of a combined Traditional Chinese Medicine approach. Electroacupuncture enhances treatment outcomes.

Development of a validated quality of life tool specific to children with bladder dysfunction.

AIMS: To date there have not been any generic or continence-specific measurement tools that allow clinicians to investigate quality of life in children with bladder dysfunction. The aim of this research was to create a cross-cultural tool to assess and measure the wider psychosocial impact of current and new interventions for bladder dysfunction in children. MATERIALS AND METHODS: The study was conducted in three parts: expert consultation with continence clinicians; design and administration of a child-completed international questionnaire; item analysis, validity and reliability testing, and design of a new tool. RESULTS: The need for a pediatric incontinence QoL measure evaluation was strongly endorsed by clinicians. Data from 156 child-completed questionnaires collected in 10 countries was analyzed for item characteristics and found to be free of item correlation and ceiling and floor effects. Factor analysis revealed 2 factors, which were labeled intrinsic and extrinsic. Rasch analyses showed the internal validity of both subscales was reasonable good. Cronbach's alpha for each factor was 0.91 and 0.72. After analysis, items were selected for the new tool, PinQ, and evaluated for ambiguity, clarity, comprehension level required, choice of words and phrases, and age-appropriate concepts. Twenty-one items were finally selected and randomly positioned within the tool. CONCLUSIONS: A cross-cultural tool that quantifies the holistic effect of bladder dysfunction in children has been designed and tested for validity.

A review of non-invasive electro neuromodulation as an intervention for non-neurogenic bladder dysfunction in children.

AIMS: The use of electrotherapeutics to improve filling and emptying dysfunction of the adult bladder has been well established, however the practice in children is less well known. The purpose of this review is to summarize the rationale behind the use of electro neuromodulation in children, examine the reported efficacy of the intervention for different presentations of dysfunction, and establish the current limitations to knowledge and practice. MATERIALS AND METHODS: A modified systematic review was carried out on all Medline studies identified as considering the use of electrotherapy or neuromodulation in children with bladder problems. Literature relating to use of this approach in adults was also searched in order to present current understanding of the treatment rationale and modes of application. RESULTS: A Medline search and handsearch of relevant conference proceedings revealed six studies of neuromodulation in children with non-neurogenic bladder dysfunction. There were no reports of the intervention in children with isolated pelvic floor dyssynergia, irritative symptoms, structural changes predisposing the pelvic floor to weakness, or monosymptomatic nocturnal enuresis. One report of the favorable effect of neuromodulation on gut dysmotility was identified. Study design and quality generated level 4 evidence. Positive post-intervention changes reported included: increased bladder capacity, decreased severity of urge, improved continence, and decrease frequency of urinary tract infection. Significant improvement in the urodynamic parameters of bladder compliance, number of uninhibited contractions, and bladder volume at first detrusor contraction were also reported. CONCLUSIONS: There are clear benefits from the use of electroneuromodulation in children with differing forms of voiding dysfunction. The treatment approach is independent of cognitive and pharmacological therapy, is minimally invasive, and free of side effects. To date, there are no clinical variables that reliably predict efficacy of electrotherapy in the various presentations of over and under active detrusor, sphincter dyssynergia, or irritative symptoms.

A pilot study of the home application of transcutaneous neuromodulation in children with urgency or urge incontinence.

PURPOSE: We evaluated the efficacy of transcutaneous neuromodulation to treat urinary urgency and urge incontinence in children with nonneurological bladder dysfunction. MATERIALS AND METHODS: Surface neuromodulation was delivered via skin electrodes away from the genital region for a short duration daily on a home treatment basis. Clinical outcome was measured by 3 tools previously tested for reliability including the frequency volume chart, urgency visual analog scale and accident diary ("Dry Pie"). RESULTS: After at least 1 month of application dryness had improved in 73.3% of children, mean urgency score had improved to equate action at urge as being 'easy to hold on' and there was a significant increase in mean voided volume. CONCLUSIONS: Initial evaluation of the home application of surface neuromodulation in children with urgency and/or urge incontinence revealed positive results and warrants a randomized controlled investigation. The finding that children were not completely dry with this treatment in isolation suggests that further study is needed to identify optimal treatment duration and stimulus intensity.