Night-time voids, level of bother and sleep characteristics in a non-patient population of wearable devices users.

INTRODUCTION: Nocturia is a highly prevalent and bothersome medical condition characterised mainly by the need to wake up to pass urine during the main sleep period. Using data from wearable devices, it is possible to examine the sleep of large cohorts in natural settings. This study seeks to use data from connected smartwatches combined with a one-time survey to explore the presence of nocturia and associated level of bother and sleep characteristics in a non-patient cohort of wearable device users representing a broad age range. METHODS: The data used come from a retrospective dataset containing sleep data from Withings watches of 250 000 users and a prospective dataset containing answers to a 10-item questionnaire completed by a subset of users in the retrospective dataset. RESULTS: The prospective dataset contained 6230 users. Overall, 6.0%, 15.3% and 38.9% of users in the age groups 18-44 years, 45-64 years and 65-90 years, respectively, reported 2 or more nocturnal voids as their customary voiding pattern, corresponding to levels of nocturia consistent with previous literature. The level of bother associated with nocturia was higher among younger users with 27.8% of users aged 18-44 years reporting that their daytime activity was highly affected versus just 14.1% among those aged 65-90 years. A higher number of reported voids per night was associated with watch-derived measures of a lower sleep efficiency, a longer awake duration at night and a shorter first uninterrupted sleep period. CONCLUSION: This study suggests not only that nocturia is present among the younger population but also that the younger are more bothered by this medical condition. Using data from wearables it was possible to establish that there is an association between the number of nocturnal voids and sleep characteristics.

Female urethral dilatation (bougierung): a case report.

BACKGROUND: Primary bladder neck obstruction is a rare clinical entity, reported to be responsible for 2.7-8% of lower urinary tract symptoms. It can lead to various urinary storage and voiding symptoms. The mainstay of treatment of female urethral strictures is urethral dilatation. Despite the long history of this method, it is unclear how far the female urethra should be dilated in correlation with residual urine volume. CASE PRESENTATION: A 79-year-old Caucasian woman presented to our institute with urgency (12-15 times/day), nocturia (3 times/night), and reoccurring urinary tract infections. A physical examination revealed no anatomical malformation in her genital organs, 150 mL post-void urine retention, and a significant narrowing in the mid-segment of the urethra (4 mm). After informed consent, our patient underwent urethral dilatation ranging from Ch9 (3 mm) to Ch39 (13 mm), and reported no symptoms at the 4-week follow-up, with no post-void residual urine. CONCLUSIONS: The relatively low (around 50%) success rate of urethral dilatation might be improved by the utilization of wider dilatators, and the relaxation of the pubourethral ligament, achieved by a gentle downward saggital push during the intervention, although long-term studies with a large number of participants are necessary to prove our hypothesis.

Dietary Sodium Restriction Reduces Nocturnal Urine Volume and Nocturnal Polyuria Index in Renal Allograft Recipients With Nocturnal Polyuria.

OBJECTIVE: To investigate whether sodium restriction alters the nocturnal urine volume (NUV) and the ratio of NUV to 24-hour urine of renal allograft recipients (RARs). MATERIALS AND METHODS: This prospective, single-center study analyzed 38 of the 59 RARs who were followed up for more than 6 months in our hospital. All patients underwent 3 sessions of dietary counseling performed by a board-certified dietitian. Before and after these 3 sessions, 24-hour urine samples were collected, along with voiding frequency volume charts. RESULTS: Of the 38 included RARs, 23 (60.5%) were diagnosed as having nocturnal polyuria (NP, NUV >10 mL/kg). After counseling the RARs with NP, their 24-hour sodium excretion was reduced from 169.5 to 125.6 mEq (P = .0066), their NUV from 862 to 709 mL (P = .021), and the ratio of NUV to 24-hour urine volume from 38.9% to 33.0% (P = .023). In contrast, these parameters were not significantly changed by dietary counseling in RARs without NP. Reduced sodium excretion and decreased NUV were significantly correlated (Spearman rho = 0.45, P = .005). CONCLUSION: Excess intake of sodium is considered a cause of NP in RARs. Dietary counseling on sodium restriction is effective in reducing NUV in RARs. Prospective studies are needed to evaluate the general population with NP.

Randomized, double-blind, placebo-controlled trial to compare solifenacin versus trospium chloride in the relief of double-J stent-related symptoms.

PURPOSE: We aimed to compare the safety and efficacy of solifenacin versus trospium chloride and compare each drug versus placebo regarding the relief of stent-related symptoms following uncomplicated ureteroscopic lithotripsy (URSL). METHODS: In a prospective, randomized, double-blind study, 210 eligible patients who underwent URSL with double-J stent insertion were recruited and randomly assigned to either the first group, receiving solifenacin (10 mg), second group, receiving trospium chloride (60 mg), or the third group, receiving placebo (one tablet). All patients were kept on study medication once daily during the entire 2-week postoperative period. All subjects were asked to complete a brief-form questionnaire to assess the lower urinary symptoms, stent-related body pain and hematuria, preoperatively and 2 weeks postoperatively. RESULTS: There were no statistically significant differences among the study groups in terms of mean age, gender, anthropometric measurements, stone and stent criteria. The overall symptom score, urgency, urge incontinence, flank pain, urethral pain and gross hematuria scores were significantly lower in solifenacin group compared to trospium chloride and placebo groups (p < 0.001). Concerning frequency and nocturia, there was no significant difference in mean scores across all groups. Drug-related side effects, particularly constipation, were higher in trospium group than in solifenacin one. CONCLUSIONS: Solifenacin treatment showed significant improvement in almost all domains of stent-related symptoms than trospium. In terms of safety and tolerance, both drugs were comparable. Future studies should be designed to address the impact of combined drugs and lower doses in the management of DJ stent-related symptoms.

Nocturia.

A 52-year-old man complains of minor urgency and frequency during the day and nocturia × 3-5. His DRE reveals a 30-g benign prostate. He is started on tamsulosin, and his daytime symptoms resolve entirely; however, he still has nocturia × 2-4. He is counseled on lifestyle modifications and to decrease fluid consumption including caffeine but has no improvement in nocturia. Cystoscopy is normal with no evident visual obstruction. A urinalysis is normal. The PVR is 40 ml. He has a normal-sized neck and does not snore. He has no trouble sleeping and awakens because of the urge to void. This is very bothersome.

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.

Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder: an indirect treatment comparison.

CONTEXT: OnabotulinumtoxinA and mirabegron have recently gained marketing authorisation to treat symptoms of overactive bladder (OAB). OBJECTIVE: To evaluate the relative efficacy of mirabegron and onabotulinumtoxinA in patients with idiopathic OAB. DESIGN: Network meta-analysis. DATA SOURCES: A search of 9 electronic databases, review documents, guidelines and websites. METHODS: Randomised trials comparing any licensed dose of onabotulinumtoxinA or mirabegron with each other, anticholinergic drugs or placebo were eligible (19 randomised trials were identified). 1 reviewer extracted data from the studies and a second reviewer checked the data. Candidate trials were assessed for similarity and networks were developed for each outcome. Bayesian network meta-analysis was conducted using both fixed-effects and random-effects models. When there were differences in mean baseline values between mirabegron and onabotulinumtoxinA trials they were adjusted for using network meta-regression (NMR). RESULTS: No studies directly comparing onabotulinumtoxinA to mirabegron were identified. A network was created for each of the 7 outcomes, with 3-9 studies included in each individual network. The trials included in the networks were broadly similar. Patients in the onabotulinumtoxinA trials had more urinary incontinence and urgency episodes at baseline than patients in the mirabegron trials and these differences were adjusted for using NMR. Both onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing the frequency of urinary incontinence, urgency, urination and nocturia. OnabotulinumtoxinA was more efficacious than mirabegron (50 and 25 mg) in completely resolving daily episodes of urinary incontinence and urgency and in reducing the frequency of urinary incontinence, urgency and urination. NMR supported the results of the network meta-analysis. CONCLUSIONS: In the absence of head-to-head trials comparing onabotulinumtoxinA to mirabegron, this indirect comparison indicates that onabotulinumtoxinA may be superior to mirabegron in improving symptoms of urinary incontinence, urgency and urinary frequency in patients with idiopathic OAB.

Physical activity and benign prostatic hyperplasia-related outcomes and nocturia.

INTRODUCTION: Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS), including nocturia, are extremely common among middle- and older-age American men. Although studies on physical activity (PA) and prevalent BPH-related outcomes suggest that PA may protect against the development of this common condition, only a few studies have examined the relation between PA and incident BPH-related outcomes and LUTS with mixed findings. In addition, although nocturia is the most commonly reported and most bothersome LUTS in men with or without evidence of BPH, few studies have examined the association of PA and nocturia independent of BPH. The purpose of this analysis was to examine the association of PA with BPH-related outcomes and nocturia in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial. METHODS: We examined this association with both prevalent (n = 28,404) and incident (n = 4710) BPH-related outcomes (measured by self-report of physician diagnosis, BPH surgery, finasteride use, and clinical indicators) and nocturia. Poisson regression with robust variance was used to calculate prevalence ratios and relative risks. RESULTS: PA was weakly positively associated with several prevalent BPH-related outcomes and was strongly inversely associated with prevalent nocturia. In incident analyses, PA was only associated with nocturia. Men who were active ≥1 h·wk(-1) were 13% less likely (95% confidence interval, 2%-22%) to report nocturia and 34% less likely (95% confidence interval, 15%-49%) to report severe nocturia as compared with men who reported no PA. The associations were similar for men with and without additional BPH-related outcomes, except for prevalent nocturia, where the association was stronger for men without other BPH-related outcomes. CONCLUSIONS: Combined with other management strategies, PA may provide a strategy for the management of BPH-related outcomes, particularly nocturia.

Ramelteon combined with an α1-blocker decreases nocturia in men with benign prostatic hyperplasia.

BACKGROUND: Nocturia is defined as waking one or more times during the night due to the urge to void. Recently, the effectiveness of several sedatives and analgesics for nocturia has been reported. We herein investigated the effects of ramelteon, an antioxidant and sleep inducer, on nocturia unresponsive to α1-blocker monotherapy in males with lower urinary tract symptoms (LUTS) as a pilot study. METHODS: Subjects were 19 patients who had LUTS suggestive of benign prostate hyperplasia, received α1-blockers (tamsulosin, silodosin, or naftopidil), and continued to have two or more episodes of nocturia per night before starting ramelteon. Ramelteon at 8 mg once daily for one month was added to the α1-blocker. A self-administered questionnaire including the International Prostate Symptom Score (IPSS), quality of life (QoL) index, Overactive Bladder Symptom Score (OABSS), and Nocturia Quality-of-Life Questionnaire (N-QOL) were assessed before and one month after starting ramelteon. RESULTS: The mean score on IPSS question 7 (nocturia) decreased significantly from 2.88 before starting ramelteon to 2.41 one month after starting the medication (P = 0.03). The mean total OABSS decreased significantly from 6.31 to 5.38 (P = 0.03), and the mean for OABSS question 2 (nighttime frequency of nocturia) also significantly decreased from 2.63 to 2.13 (P = 0.01). The mean total N-QOL score did not change significantly. Two patients had dizziness; the remaining patients had no adverse drug-related events. CONCLUSIONS: Ramelteon in combination with an α1-blocker could be a treatment option for reducing nocturia in men with BPH.

Nonsteroidal antiinflammatory drug use and lower urinary tract symptoms: results from the Boston area community health survey.

There is evidence for a role of inflammation in the etiology of lower urinary tract symptoms (LUTS), raising the possibility that use of nonsteroidal antiinflammatory drugs (NSAIDs) may inhibit the development or progression of LUTS. The authors examined the association between use of prescription and over-the-counter NSAIDs and LUTS among 1,974 men and 2,661 women in the Boston Area Community Health Survey (2002-2005). Multivariable-adjusted logistic regression was used to estimate odds ratios and 95% confidence intervals for LUTS, voiding symptoms, storage symptoms, and nocturia. There was no clear association between use of prescription or over-the-counter NSAIDs (compared with no NSAID use) and overall LUTS, voiding symptoms, or nocturia in men or women. However, over-the-counter NSAID use was positively associated with storage symptoms in women (odds ratio = 1.37, 95% confidence interval: 1.03, 1.83), and there was a positive association between over-the-counter NSAID use and overall LUTS among women with a history of arthritis (odds ratio = 2.09, 95% confidence interval: 1.20, 3.64). These results do not provide strong support for an association between NSAIDs and LUTS. However, the associations between over-the-counter NSAID use and certain urologic symptoms, particularly among women with arthritis, and the potential mechanisms involved should be evaluated in future studies.

Impact of Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: This study aims to investigate the impact of the Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse. METHODS: Seventy-one consecutive patients who underwent the Prolift procedure were evaluated on the subjective reporting of symptoms and objective urodynamic measurements pre- and 1 year postoperatively. RESULTS: Subjective symptoms significantly improved after surgery included frequency, urgency incontinence, straining to void, incomplete bladder emptying, and poor urine stream but the incidence of stress urinary incontinence was unchanged. Compared with preoperative urodynamic measurements, the residual urine volume, maximal bladder capacity, and urethral closure pressure significantly decreased postoperatively. CONCLUSIONS: After 1-year follow-up, the Prolift procedure resulted in reduced storage function and impaired bladder capacity urodynamically, but emptying function improved. Lower urinary tract symptoms were significantly improved, except for an unchanged incidence of stress urinary incontinence. Women should be informed of the possible impacts before the procedure.

The use of oestradiol therapy in postmenopausal women after TVT-O anti-incontinence surgery.

OBJECTIVE: To investigate whether patients who were treated with TVT-O procedure for urodynamic stress incontinence had a significant improvement in their urodynamic findings and their post-operative symptoms (frequency, urgency, nocturia) if they were treated post-operatively with vaginal oestradiol for 6 months compared to the non-treated group. METHODS: Prospective randomised study. 190 patients were asked to participate in our study. Finally, a total of 92 patients in group 1 and 91 patients in group 2 completed the study. In group 1, which was the treatment group, patients having the TVT-O procedure for urodynamic stress incontinence were instructed to use post-operatively oestradiol tablets, 25 micrograms (Vagifem, Novo Nordisk) vaginally, once daily, nocte, for 2 weeks and then twice weekly for 6 months. The patients in group 2 (control group) had the TVT-O procedure only. All patients were reviewed in 2 months and again in 6 months time. RESULTS: There was no statistically significant difference between the two groups concerning pre-operative and post-operative haemoglobin, operative time, hospital stay or return to work. The within group analysis did not show significant differences between pre-operative and post-operative urodynamic data in both groups. Patients treated with vaginal estradiol post-operatively showed a statistically significant reduction in relation to the symptoms of urgency and frequency but not in relation to nocturia and urge incontinence compared to the non-treated group. There is no difference in relation to the efficacy of TVT-O procedure between the groups at 6 months follow-up. CONCLUSION: It appears that vaginal oestradiol treatment could be offered to postmenopausal patients after a TVT-O procedure having the symptoms of frequency and urgency provided they are aware of the lack of evidence regarding long term benefit.

[Impact of sacrospinous vaginal vault suspension on the anterior compartment]. / Impacto de la suspensión de la cúpula vaginal al ligamento sacroespinoso sobre el compartimiento anterior.

OBJECTIVES: A prospective study was conducted to assess the efficacy of sacrospinous vaginal vault fixation and its impact on the anterior compartment. The Pelvic Organ Prolapse Quantification (POP-Q) system was used to quantify pelvic organ prolapse in the apical and anterior vaginal compartments. METHODS: Fifty-eight patients underwent a procedure to correct apical prolapse from March 2003 to February 2006. Mean preoperative and postoperative POP-Q scores were respectively: Aa (+0.74; -1.45); Ba (+3.17; -1.36); C (+3.41; -7.71) (p<0.001). RESULTS: Cure rate was 93.1%. Preoperative and postoperative evaluation of the anterior vaginal compartment was respectively: stage 1 (5.2%; 48.3%), stage 2 (6.9%; 34.5%), stage 3 (74.1%; 5.2%), and stage 4 (13.8%; 0%). De novo cystocele occurred in 87.9% of cases. An improvement was seen in lower urinary tract symptoms of urgency, nocturia, and urge incontinence. CONCLUSIONS: Sacrospinous vaginal vault suspension is effective for the treatment of apical prolapse and leads to formation of cystocele in most cases.

Solifenacin for overactive bladder in women unsuccessfully treated with immediate release oxybutynin: a pilot study.

The aim of the study was to determine the efficacy, tolerability and cost comparison of solifenacin for women with an overactive bladder (OAB) who failed to respond to immediate release oxybutynin (IR). A standard 3-day bladder diary, cost of incontinence pads used over 4 weeks and a validated OAB quality-of-life questionnaire were collected at baseline, at 4 weeks and at 12 weeks of commencing solifenacin treatment. Nine women were enrolled into the study. Eight of the women completed the 12-week study and one woman withdrew. The mean number of day-time micturitions was 11.4 +/- 2.7 at baseline and 7.3 +/- 3.5 at 12 weeks of solifenacin treatment (p = 0.0002). The mean number of nocturia was 2.8 +/- 1.4 at baseline and 0.9 +/- 0.9 at 12 weeks of solifenacin treatment (p = 0.0004). The total number of incontinence episodes per day was 4.9 +/- 4.6 at baseline and 1.9 +/- 2.7 at 12 weeks of solifenacin treatment (p = 0.02). The mean micturition volumes were 160 +/- 50 ml at baseline and 280 +/- 50 ml at 12 weeks of solifenacin treatment (p = 0.002). The symptom severity domain of the OAB-questionnaire (OAB-q) showed a value of 60.8 +/- 23.0% at baseline and 32.0 +/- 25.9 % at 12 weeks of solifenacin treatment (p = 0.001). The health-related quality-of-life (HRQL) domain of the OAB-q showed a value of 45.5 +/- 28.0% at baseline and 73.3 +/- 24.8% at 12 weeks of solifenacin treatment (p = 0.0006). This study shows a significant improvement in bladder diary and validated quality-of-life parameters with solifenacin in women with urge incontinence who have previously failed to respond to or have been intolerant of oxybutynin IR.

Aging, circadian weight change, and nocturia.

BACKGROUND: Normal young individuals excrete more sodium in their urine during the day than overnight, but the reverse occurs in older individuals with nocturia. The reason is unknown. METHODS: First, a self-study was performed, determining the relation between morning and night weight change as an index of volume expansion. This was followed for 1 year and modified, in separate experiments, by assessing either a diuretic (furosemide 40 mg) or recumbency. Weight and in some instances ankle circumference were measured, and day and night urines collected. Second, a community study of 102 individuals was done, measuring circadian weight change and nocturia for 3 days in each subject. Third, measurement of day and night urine electrolytes and weight change was performed in 10 non-nocturics and 12 matched nocturics (age > or =60 years). RESULTS: Salt and water retention occurs during the day and natriuresis and diuresis overnight. Nocturia occurs when weight gain is greater. It is prevented by an afternoon diuretic or daytime recumbency. CONCLUSIONS: Idiopathic nocturia is due to daytime volume expansion associated with the upright position. It is hypothesized that this is caused by sodium retention during the day mediated by renal nerve sympathetic activity which together with angiotensin II acts on the kidney to increase tubular sodium reabsorption either directly or by reducing daytime glomerular filtration rate.

The MATRIX study: evaluating the data in older adults.

In summary, the MATRIX study evaluated the use of OXY-TDS in older adults residing in community settings. Although it was a community-based study, a large segment of those studied had traits similar to those residing in long-term care settings--699 patients were aged 75 years or older; many had comorbid diseases; and many had a long history of OAB. MATRIX found that the transdermal form of oxybutynin was a safe and effective method to manage OAB in this older population. Adverse events reported were minor and local, with the most common event being local skin irritation. The transdermal formulation improved the symptoms associated with OAB and improved QOL. Although nursing home residents were not studied in MATRIX, it appears that the transdermal formulation of oxybutynin would be an agent of choice in older adults.