Nocturia treatment outcomes: Analysis of contributory frequency volume chart parameters

Epstein, Matthew; Blaivas, Jerry G.; Wein, Alan J.; Weiss, Jeffrey P.

doi:10.1002/nau.23272

Cited by 16 publications

(18 citation statements)

References 17 publications

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“…There were no differences in baseline voiding parameters between responders and non‐responders with low global bladder capacity, except for initial nocturia severity. This mirrors previous findings of greater nocturia severity at baseline in nocturia responders of all etiologies . This finding conveys some potential implications in counseling patients bothered by nocturia.…”

Section: Discussionsupporting

confidence: 87%

“…This is reflected in decreased 24‐hour urine volume. Fluid restriction is already an accepted method of achieving improvement in nocturia severity; this study provides additional evidence to seek means to diminish nocturnal urine output in patients with low capacity bladders—whether or not nocturnal polyuria is present . Notably, fluid restriction should be implemented safely in patients more susceptible to dehydration, and particular care must be taken when treating the elderly, who have a decreased thirst response to dehydration and can less reliably self‐regulate hydration .…”

Section: Discussionmentioning

confidence: 89%

“…Although the urologist's toolkit continues to expand, clinical drug trials have shown statistically significant—but clinically equivocal—outcomes, and real‐world observational studies have likewise demonstrated poor efficacy of treatment directed at nocturia owing to diminished bladder capacity . As such, an effective standard management strategy for the treatment of nocturia due to low capacity bladder has yet to be identified.…”

Section: Introductionmentioning

confidence: 99%

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Etiology of nocturia response in men with diminished bladder capacity

Epstein

Monaghan

Weiss

2018

Neurourology and Urodynamics

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Aims To test the hypothesis that patients with nocturia owing to diminished global or nocturnal bladder capacity improve via increased bladder capacity. Methods This is a retrospective analysis of voiding diaries completed at a VA urology clinic between 2008–2017. Inclusion required patients aged at least 18 years, male, undergoing treatment for nocturia, and having completed at least two 24‐hour voiding diaries ≥1 month apart. Patients were divided into two cohorts: responders (any decline in nocturia) and non‐responders (no change or any increase in nocturia). Patients were further sub‐stratified as having low global bladder capacity (maximum voided volume [MVV] <200 mL) versus low nocturnal bladder capacity (nocturnal maximum voided volume [NMVV] <200 mL and MVV ≥200 mL). Wilcoxon rank‐sum was applied with a Bonferroni correction to test significance. Results Forty pre‐ and post‐treatment diaries from 27 patients, and 19 pre‐ and post‐treatment diaries from 17 patients were identified as having low global and low nocturnal bladder capacity, respectively. Nocturia responders with low global bladder capacity demonstrated significant decline compared to non‐responders in nocturnal urine volume (NUV) (−140 vs +75, P < 0.01) and nocturnal bladder capacity index (NBCi) (−0.59 vs +0.23, P < 0.01). Patients with low nocturnal bladder capacity similarly demonstrated decreased NUV (−30 vs +160, P = 0.04) and NBCi (−1.4 vs +0.33, P < 0.01). There was no significant change in MVV or NMVV for either group. Conclusions Treatment directed at lowering nocturnal urine production and enabling patients to consistently void at capacity is a rational strategy to treat nocturia in patients with low bladder capacity.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Etiology of nocturia response in men with diminished bladder capacity

Epstein

Monaghan

Weiss

2018

Neurourology and Urodynamics

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“…The nocturia index (Ni; NUV/24‐hour maximum voided volume), which reflects the mismatch between nocturnal production and storage capacity, is the voiding diary parameter most strongly correlated with nocturia severity, and could reasonably be modified by substituting nocturnal maximum voided volume in the denominator (ie, NUV/nocturnal maximum voided volume), as nocturnal maximum voided volumes have been identified as a major factor associated with nocturia . Both a reduction in NUV and prolongation of the first uninterrupted sleep period have been shown to accompany an improvement in nocturia severity …”

Section: Discussionmentioning

confidence: 99%

Identifying men with global polyuria on a nocturnal‐only voiding diary

Monaghan

Rahman

Bliwise

et al. 2019

Neurourology and Urodynamics

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Aims: Nocturnal polyuria (NP) and global polyuria (GP) are not mutually exclusive. However, by rate, the common criteria for GP (40 mL/kg/24 hours [117 mL/kg/hour in a 70-kg individual] or 3000 mL/24 hours [125 mL/h]) are more stringent than those for NP (90 mL/hour during the sleep period or NP index [NPi; nocturnal volume/24-hour volume] > 0.33 [no minimum rate]). It remains unclear whether total nocturnal urine volume (NUV) may reliably delineate between NP patients with and without comorbid GP. Methods: A clinical database of men with lower urinary tract symptoms was searched for voiding diaries completed by patients reporting greater than or equal to 1 nocturnal void(s). Four separate analyses were performed using all combinations of the two NP and two GP criteria listed above. For each analysis, patients were included if they met the criteria for NP, and then stratified by presence or absence of GP (ie, NP + GP vs isolated NP). Results: Median NUV was greater among patients with NP + GP for all criteria combinations. Sensitivities greater than or equal to 80%/90%/100% for NP + GP were observed at 1275/1230/1085 mL for {NPi > 0.33 + 24-hour volume > 3000 mL}; 1075/1035/1035 mL for {NPi > 0.33 + 24-hour volume > 40 mL/kg}; 900/ 745/630 mL for {NUP > 90 mL/hour + 24-hour volume > 3000 mL}; and 1074/ 1035/990 mL for {NUP > 90 mL/hour + 24-hour volume > 40 mL/kg}. Conclusions: An inordinate NUV among men with NP is fairly sensitive for comorbid GP. In the appropriate clinical setting, nocturnal-only diaries may suffice in the evaluation and follow-up of patients with NP, so long as outlying nocturnal volumes prompt a 24-hour diary/urine collection. K E Y W O R D S adherence, global polyuria, nocturia, nocturnal polyuria, sensitivity, specificity

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“…FVCs/BDs are therefore essential to record voiding parameters and allow accurate recording of nocturnal urine production, which can predict the severity and improvement of nocturia. 22,23 Therefore, timing, number of voids and volume of urine voided should be recorded as accurately as possible. The recording of fluid intake that is provided with BDs offers an advantage of BDs over standard FVCs.…”

Section: Patient Evaluationmentioning

confidence: 99%