Introduction: Nocturia has a
multifactorial etiology, and its diagnostic approach involves, in addition to
medical history and physical examination, the use of a bladder diary to define
the pathophysiological mechanisms present in each case. Methods: This study
investigated the prevalence of nocturia, its mechanisms,
and associated factors in women with lower urinary tract symptoms
attending two urogynecology clinics in the state of Rio de Janeiro, Brazil.
Anamnesis, physical examination, and a 24-hour bladder diary were conducted.
Two definitions of nocturia were considered: one or more nighttime voids and
two or more nighttime voids. Mann-Whitney and Chi-square tests were used, with
p-value ≤ 0.05 considered significant. Results: A
total of 133 participants were included. The majority were aged 60 years or
older (61.4%) and had three or more comorbidities (66.7%), with systemic
arterial hypertension being the most prevalent (59.1%). Of the total
participants, 54 (41.4%) completed the bladder diary. Among those with one or
more nighttime voids (70.7%), the prevalence of nocturnal polyuria was 69.1%,
reduced nocturnal bladder capacity was 17.3%, and global polyuria was 12.9%.
Among participants with two or more nighttime voids (56.4%), the prevalences
were respectively 68.2%, 19.1%, and 13.6%. Among the mechanisms, associations
were found only with global polyuria, namely: use of insulin, body mass index
and tobacco consumption. An association was also found between recurrent
urinary tract infection and global polyuria in participants with two or more
nighttime voids. Conclusions: The prevalence of nocturia was higher than that
reported in general population studies and specialized services for lower
urinary tract symptoms. Nocturnal polyuria was the most prevalent mechanism.
Associations were observed between the use of insulin, body mass index, tobacco
consumption, and recurrent urinary tract infection with global polyuria. No
associations were found between any clinical or demographic variables and
nocturnal polyuria or reduced nocturnal bladder capacity.
References
[1]
Hashim, H., Blanker, M.H., Drake, M.J., Djurhuus, J.C., Meijlink, J., Morris, V., et al. (2019) International Continence Society (ICS) Report on the Terminology for Nocturia and Nocturnal Lower Urinary Tract Function. Neurourology and Urodynamics, 38, 499-508. https://doi.org/10.1002/nau.23917
[2]
Tikkinen, K., Johnson, T.M., Tammela, T.L.J., Sintonen, H., Haukka, J., Huhtala, H., et al. (2010) Nocturia Frequency, Bother, and Quality of Life: How Often Is Too Often? A Population-Based Study in Finland. European Urology, 57, 488-498.
https://doi.org/10.1016/j.eururo.2009.03.080
[3]
Yow, H.Y., Tiong, J.J.L., Mai, C.W., van der Werf, E., Zainuddin, Z.M., Toh, C.C., et al. (2021) Prevalence of Nocturia among Community-Dwelling Adults: A Population-Based Study in Malaysia. BMC Urology, 21, Article No. 95.
https://doi.org/10.1186/s12894-021-00860-1
[4]
Daugherty, M., Ginzburg, N. and Byler, T. (2021) Prevalence of Nocturia in United States Women: Results from National Health and Nutrition Examination Survey. Female Pelvic Medicine and Reconstructive Surgery, 27, e52-e58.
https://doi.org/10.1097/SPV.0000000000000792
[5]
Madhu, C., Coyne, K., Hashim, H., Chapple, C., Milsom, I. and Kopp, Z. (2015) Nocturia: Risk Factors and Associated Comorbidities; Findings from the EpiLUTS Study. International Journal of Clinical Practice, 69, 1508-1516.
https://doi.org/10.1111/ijcp.12727
[6]
Soler, R., Gomes, C.M., Averbeck, M.A. and Koyama, M. (2017) The Prevalence of Lower Urinary Tract Symptoms (LUTS) in Brazil: Results from the Epidemiology of LUTS (Brazil LUTS) Study. Neurourology and Urodynamics, 37, 1356-1364.
https://doi.org/10.1002/nau.23446
[7]
Irwin, D.E., Abrams, P., Milsom, I., Kopp, Z. and Reilly, K. (2008) Understanding the Elements of Overactive Bladder: Questions Raised by the EPIC Study. BJU International, 101, 1381-1387. https://doi.org/10.1111/j.1464-410X.2008.07573.x
[8]
Offiah, I., Drake, M.J. and Gammie, A. (2022) Implications of Underactive Bladder Syndrome for Nocturia. Do We Need Urodynamic Assessment? European Urology Focus, 8, 86-88. https://doi.org/10.1016/j.euf.2021.12.013
[9]
Pauwaert, K., Goessaert, A.S., Ghijselings, L., Monaghan, T.F., Depypere, H. and Everaert, K. (2021) Nocturia through the Menopausal Transition and Beyond: A Narrative Review. International Urogynecology Journal, 32, 1097-1106.
https://doi.org/10.1007/s00192-020-04640-7
[10]
Reyes, P.B.G., Butcher, K., Cotterill, N., Drake, M.J., Gimson, A., Gogola, L., et al. (2022) Implications of Cardiovascular Disease for Assessment and Treatment of Nocturia in Primary Care: Systematic Review and Nominal Group Technique Consensus. European Urology Focus, 8, 26-32. https://doi.org/10.1016/j.euf.2021.12.014
[11]
Papworth, E., Dawson, S., Henderson, E.J., Eriksson, S.H., Selsick, H., Rees, J., et al. (2022) Association of Sleep Disorders with Nocturia: A Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment. European Urology Focus, 8, 42-51. https://doi.org/10.1016/j.euf.2021.12.011
[12]
Dawson, S., Duncan, L., Ahmed, A., Gimson, A., Henderson, E.J., Rees, J., et al. (2022) Assessment and Treatment of Nocturia in Endocrine Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. European Urology Focus, 8, 52-59. https://doi.org/10.1016/j.euf.2021.12.008
[13]
Hashimoto, Y., Tanaka, M., Yamazaki, M., Nakano, K., Ushigome, E., Okada, H., et al. (2016) Caffeine Intake Enhances the Benefits of Sodium Glucose Transporter 2 Inhibitor. Diabetes/Metabolism Research and Reviews, 32, 694-699.
https://doi.org/10.1002/dmrr.2789
[14]
Kanbay, M., Turgut, F., Erkmen Uyar, M., Akcay, A. and Covic, A. (2008) Causes and Mechanisms of Nondipping Hypertension. Clinical and Experimental Hypertension, 30, 585-597. https://doi.org/10.1080/10641960802251974
[15]
Nguyen, L.N., Randhawa, H., Nadeau, G., Cox, A., Hickling, D., Campeau, L., et al. (2022) Canadian Urological Association Best Practice Report: Diagnosis and Management of Nocturia. Canadian Urological Association Journal, 16, E336-E349.
https://doi.org/10.5489/cuaj.7970
[16]
Fisch, G.Z., Fang, A.H., Miller, C.D., Choi, C., Monaghan, T.F., Smith, E.F., et al. (2022) Polyuria in Patients with Lower Urinary Tract Symptoms: Prevalence and Etiology. Neurourology and Urodynamics, 42, 256-262.
https://doi.org/10.1002/nau.25078
[17]
Mueller, E.R., Weiss, J.P., Bosch, J., Chughtai, B., Rosenberg, M.T., Bacci, E.D., et al. (2023) Nocturnal Polyuria in Women: Results from the EpiNP Study. International Urogynecology Journal, 34, 1743-1751. https://doi.org/10.1007/s00192-022-05432-x
[18]
Weiss, J.P., Bosch, J., Chapple, C.R., Bacci, E.D., Simeone, J.C., Rosenberg, M.T., et al. (2022) The Prevalence of Nocturnal Polyuria in the United States: Results from the Epidemiology of Nocturnal Polyuria Study. European Urology Focus, 8, 1415-1423. https://doi.org/10.1016/j.euf.2021.12.016
[19]
Vahabi, B., Jabr, R., Fry, C., McCloskey, K., Everaert, K., Agudelo, C.W., et al. (2020) ICI-RS 2019 Nocturia Think Tank: How Can Experimental Science Guide Us in Understanding the Pathophysiology of Nocturia? Neurourology and Urodynamics, 39, S88-S95. https://doi.org/10.1002/nau.24274
Aziz, I., Whitehead, W.E., Palsson, O.S., Törnblom, H. and Simrén, M. (2020) An Approach to the Diagnosis and Management of Rome IV Functional Disorders of Chronic Constipation. Expert Review of Gastroenterology & Hepatology, 14, 39-46.
https://doi.org/10.1080/17474124.2020.1708718
[22]
Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J., et al. (2022) Prevalence and Factors Associated with Polypharmacy: A Systematic Review and Meta-Analysis. BMC Geriatrics, 22, Article No. 601.
https://doi.org/10.1186/s12877-022-03279-x
[23]
Abarca-Gómez, L., Abdeen, Z.A., Hamid, Z.A., Abu-Rmeileh, N.M., Acosta-Cazares, B., Acuin, C., et al. (2017) Worldwide Trends in Body-Mass Index, Underweight, Overweight, and Obesity from 1975 to 2016: A Pooled Analysis of 2416 Population-Based Measurement Studies in 128.9 Million Children, Adolescents, and Adults. The Lancet, 390, 2627-2642. https://doi.org/10.1016/S0140-6736(17)32129-3
[24]
Madhu, C., Swift, S., Moloney-Geany, S. and Drake, M.J. (2018) How to Use the Pelvic Organ Prolapse Quantification (POP-Q) System? Neurourology and Urodynamics, 37, S39-S43. https://doi.org/10.1002/nau.23740
Cruz, R., Garcia-Rosa, M. and Faria, C. (2020) Prevalence and Associated Factors in Community-Dwelling Subjects—A Population-Based Study. Revista da Associação Médica Brasileira, 66, 830-837. https://doi.org/10.1590/1806-9282.66.6.830
[27]
Clemens, J.Q., Wiseman, J.B., Smith, A.R., Amundsen, C.L., Yang, C.C., Bradley, M.S., et al. (2020) Prevalence, Subtypes, and Correlates of Nocturia in the Symptoms of Lower Urinary Tract Dysfunction Research Network Cohort. Neurourology and Urodynamics, 39, 1098-1107. https://doi.org/10.1002/nau.24338
[28]
Drangsholt, S., Peyronnet, B., Arcila-Ruiz, M., Sussman, R.D., Palmerola, R., Pape, D.R., et al. (2019) Nocturia in Female Patients: Current Clinical Features, Treatment Patterns and Outcomes at a Tertiary Referral Centre. Arab Journal of Urology, 17, 82-86. https://doi.org/10.1080/2090598X.2019.1589792
[29]
Oelke, M., De Wachter, S., Drake, M.J., Giannantoni, A., Kirby, M., Orme, S., et al. (2017) A Practical Approach to the Management of Nocturia. International Journal of Clinical Practice, 71, e13027. https://doi.org/10.1111/ijcp.13027
[30]
Azuero, J., Santander, J., Trujillo, C.G., Caicedo, J.I., Zuluaga, L., Becerra, A.M., et al. (2021) Potential Associations of Adult Nocturia. Results from a National Prevalence Study. Neurourology and Urodynamics, 40, 819-828.
https://doi.org/10.1002/nau.24624
[31]
Moon, S., Chung, H.S., Yu, J.M., Ko, K.J., Choi, D.K., Kwon, O., et al. (2019) The Association between Obesity and the Nocturia in the U.S. Population. International Neurourology Journal, 23, 169-176. https://doi.org/10.5213/inj.1938062.031
[32]
Erdogan, B.R., Liu, G., Arioglu-Inan, E. and Michel, M.C. (2022) Established and Emerging Treatments for Diabetes-Associated Lower Urinary Tract Dysfunction. Naunyn-Schmiedeberg’s Archives of Pharmacology, 395, 887-906.
https://doi.org/10.1007/s00210-022-02249-9
[33]
Chang, C.J., Pei, D., Wu, C.C., Palmer, M.H., Su, C.C., Kuo, S.F., et al. (2017) Correlates of Nocturia and Relationships of Nocturia with Sleep Quality and Glycemic Control in Women with Type 2 Diabetes. Journal of Nursing Scholarship, 49, 400-410. https://doi.org/10.1111/jnu.12302
[34]
Wang, Y., Hu, H., Xu, K., Zhang, X., Wang, X., Na, Y., et al. (2014) Prevalence, Risk Factors, and Symptom Bother of Nocturia: A Population-Based Survey in China. World Journal of Urology, 33, 677-683. https://doi.org/10.1007/s00345-014-1411-5
[35]
Musameh, M.D., Nelson, C.P., Gracey, J., Tobin, M., Tomaszewski, M. and Samani, N.J. (2016) Determinants of Day-Night Difference in Blood Pressure, a Comparison with Determinants of Daytime and Night-Time Blood Pressure. Journal of Human Hypertension, 31, 43-48. https://doi.org/10.1038/jhh.2016.14
[36]
Omvik, P. (1996) How Smoking Affects Blood Pressure. Blood Pressure, 5, 71-77.
https://doi.org/10.3109/08037059609062111
[37]
Kuo, H.C., Ke, Q.S. and Lee, C.L. (2021) Recurrent Urinary Tract Infection in Women and Overactive Bladder—Is There a Relationship? Tzu Chi Medical Journal, 33, 13-21. https://doi.org/10.4103/tcmj.tcmj_38_20
[38]
Jung, C. and Brubaker, L. (2019) The Etiology and Management of Recurrent Urinary Tract Infections in Postmenopausal Women. Climacteric, 22, 242-249.
https://doi.org/10.1080/13697137.2018.1551871
