Marie-Astrid Denys

Lower urinary tract symptoms and metabolic disorders: ICI-RS 2014.

To investigate the link between lower urinary tract symptoms (LUTS) and metabolic disorders.

ICI‐RS 2015—Is a better understanding of sleep the key in managing nocturia?

Nocturia, or waking up at night to void, is a highly prevalent and bothersome lower urinary tract symptom. However, the applied treatment modalities do not improve symptoms in about half of the patients. The aim of this report is to generate new ideas for future nocturia research, with special emphasis on the role of sleep physiology and sleep disorders.

Circadian Rhythms in Water and Solute Handling in Adults with a Spinal Cord Injury

Purpose: We evaluated nocturnal urine production and circadian rhythms of renal function (glomerular filtration, and water and solute diuresis) in adults with spinal cord injury compared to controls. Materials and Methods: This prospective observational study was done at Ghent University Hospital, Belgium. Participants were asked to perform a 24‐hour urine collection. A blood sample was taken to calculate the diuresis rate and the renal clearance of creatinine, free water, solutes, sodium and urea. Results: A total of 119 patients were divided into 32 with spinal cord injury, and 68 controls with and 19 without nocturnal polyuria. Spinal cord injured patients showed no circadian rhythms in the diuresis rate or in the renal clearance of creatinine, free water, solutes, sodium or urea. Controls without nocturnal polyuria reported a lower nighttime diuresis rate and lower nighttime clearance of creatinine, solutes, sodium and urea compared to daytime levels. Controls with nocturnal polyuria had no circadian rhythms in the diuresis rate or creatinine clearance and a significant increase in nocturnal free water clearance compared to daytime levels. Conclusions: Comparing the mechanisms underlying nocturnal urine production between patients with spinal cord injury and controls revealed important differences. Spinal cord injured patients showed absent circadian rhythms in the renal clearance of creatinine (glomerular filtration), free water (water diuresis) and solutes such as sodium and urea (solute diuresis). Future research must be done to evaluate the role of patient stratification to find the most effective and safe treatment or combination of treatments for spinal cord injured patients with complaints or complications related to nocturnal polyuria.

Pitfalls and opportunities in multidisciplinary research about nocturia in adults

Objectives: Describe current shortcomings in clinical research on the treatment of nocturia in adults, and suggest new directions for future studies in this field. Methods: A literature search was conducted using the keywords ‘nocturia,’ ‘nocturnal polyuria,’ ‘sleep,’ and ‘hypertension.’ Results: Nocturia, or waking up at night to void, is a highly prevalent and bothersome lower urinary tract symptom (LUTS) affecting up to 40% of adults. Since the majority of patients are diagnosed with nocturnal polyuria (NP) as one of the underlying causes, it is not surprising that the effect of treatments for overactive bladder (OAB) and bladder outlet obstruction (BOO) are disappointing with regard to nocturia. Therefore, we suggest to conduct studies in which nocturic patients are treated according to the underlying pathophysiology: (1) antimuscarinics or β3-agonists for OAB symptoms, (2) α-blockers or 5α-reductase inhibitors in men with BOO caused by enlarged prostates, (3) desmopressin or diuretics for NP, (4) continuous positive airway pressure in nocturic patients with obstructive sleep apnea, and (5) all its combinations in case of combined pathophysiology. Not only the effect on treatment efficacy or side effects needs to be assessed, but also the impact on related comorbidities such as sleep disorders, hypertension, and endocrine functions such as blood glucose regulation. Conclusion: Future research needs to subtype nocturic patients in order to adapt treatment according to the underlying cause.

Nocturnal polyuria in a nursing home and effect on quality of life

To the Editor: Nocturnal polyuria (NP) is a condition with a high prevalence in older people. It can present as nocturia or nocturnal incontinence, both highly bothersome urological complaints. Despite the high prevalence and a distinct effect on quality of life and sleep, research on this topic within the nursing home setting is lacking, so this study evaluated NP and associated bladder and qualityof-life characteristics in a nursing home. Data were collected between October and November 2012 in a Belgian nursing home for this prospective study. Fifty-five of the 190 residents were eligible for inclusion and completed the study protocol, which comprised validated questionnaires to evaluate quality of life (Medical Outcomes Study 36-item Short-Form Survey (SF-36)) and urinary symptoms (International Consultation on Incontinence modular Questionnaire (ICIQ) for lower urinary tract symptoms in men (MLUTS) and women (FLUTS)) and a 24-hour frequency volume chart with registration of frequency and volume of each micturition or the weight of incontinence briefs. The mean age of the total group was 87 6.3 (10 male, 45 female). Based on the International Continence Society definition that NP is a nocturnal urine volume exceeding 33% of 24-hour urine production (nocturnal polyuria index, NPI), 46 (84%) subjects had NP, and nine (16%) did not. The NP group had shorter nocturnal bedrest (13 2 hours vs 15 2 hours, P < .007), more use of incontinence material (52% vs 11%, P < .02), and drank less (1,048 326 mL vs 1,313 388 mL, P = .04) than the control group. Nocturnal urine volume was higher in the NP group (898 814 mL vs 328 144 mL, P = .04). Lower quality-of-life scores were found in the NP group for emotional well-being (P = .007) and pain (P = .05). Differences based on the presenting symptom were evaluated in the NP group. Seventeen subjects reported nocturnal incontinence (37%). The prevalence of nocturia could not be determined because 24 subjects used incontinence briefs (52%). Four subjects wearing incontinence material reported no nocturnal incontinence, meaning that they voided actively, but wore incontinence material because of physical or mental disabilities. The 22 subjects without incontinence material all reported nocturia. No significant differences were found between the group with nocturnal incontinence and the group without in terms of drinking volume, total urine volume over 24 hour, nocturnal urine volume, NPI, or quality of life, although significant differences in all study domains are found when comparing subjects with and without incontinence material in the NP group (Table 1). Receiver operating characteristic (ROC) curve analysis of nocturnal volume according to incontinence material shows an area under the curve of 78% (sensitivity 76%, specificity 77%) for a volume of 625 mL (P < .001). The main conclusion of this study is that the most important differences in bladder and quality-of-life characteristics within the NP group are based on the use of incontinence material. Nocturnal urine volumes were significantly higher in the group with incontinence material. The analysis shows that a nocturnal volume of 625 mL or more is a risk factor for the need for incontinence material, which suggests that nocturnal overdistension of the bladder Table 1. Symptoms, Frequency Voiding Chart Parameters, and Quality-of-Life Scores of Subjects with Nocturnal Polyuria with and without Incontinence Material (N = 46)

Validated uroflowmetry‐based predictive model for the primary diagnosis of urethral stricture disease in men

To define a uroflowmetry‐based non‐invasive predictive tool for the primary diagnosis of urethral stricture disease.

Commentary on “No effect of basic bladder advice in enuresis: A randomized controlled trial”

Cederblad et al. [1] are the first to report results of a randomized clinical trial (RCT) assessing whether the recommendation to initially treat all children suffering from nocturnal enuresis (NE) with basic bladder advice (BBA) can be supported by evidence. Forty children aged 6 years and older with primary untreated NE and without daytime incontinence were randomized to receive either first BBA during 1 month and then alarm therapy (AT) for 8 weeks, or only AT. Since BBA did not reduce enuresis frequency or the end results after the AT, the authors concluded that the recommendation to treat all children with BBA first cannot be supported and recommend to start with the AT or desmopressin as first-line treatment [1]. The research question was relevant and interesting. However, we feel that the conclusion cannot be supported because of important methodological flaws.

A different way to study frequency volume charts in patients with nocturia

Nocturia results from a mismatch between bladder capacity and nocturnal urine production (NUP), which is determined with a frequency volume charts (FVC).

Systematic review of proposed definitions of nocturnal polyuria and population-based evidence of their diagnostic accuracy

ABSTRACT Background Evidence of diagnostic accuracy for proposed definitions of nocturnal polyuria is currently unclear. Purpose Systematic review to determine population-based evidence of the diagnostic accuracy of proposed definitions of nocturnal polyuria based on data from frequency–volume charts. Methods Seventeen pre-specified search terms identified 351 unique investigations published from 1990 to 2016 in BIOSIS, Embase, Embase Alerts, International Pharmaceutical Abstract, Medline, and Cochrane. Thirteen original communications were included in this review based on pre-specified exclusion criteria. Data were extracted from each paper regarding subject age, sex, ethnicity, health status, sample size, data collection methods, and diagnostic discrimination of proposed definitions including sensitivity, specificity, positive and negative predictive value. Results The sample size of study cohorts, participant age, sex, ethnicity, and health status varied considerably in 13 studies reporting on the diagnostic performance of seven different definitions of nocturnal polyuria using frequency-volume chart data from 4968 participants. Most study cohorts were small, mono-ethnic, including only Caucasian males aged 50 or higher with primary or secondary polyuria that were compared to a control group of healthy men without nocturia in prospective or retrospective settings. Proposed definitions had poor discriminatory accuracy in evaluations based on data from subjects independent from the original study cohorts with findings being similar regarding the most widely evaluated definition endorsed by ICS. Conclusions Diagnostic performance characteristics for proposed definitions of nocturnal polyuria show poor to modest discrimination and are not based on sufficient level of evidence from representative, multi-ethnic population-based data from both females and males of all adult ages.

Basic or extended urine sampling to analyse urine production

Frequency volume charts are valuable tools to objectify urine production in patients with nocturia, enuresis or nocturnal incontinence. Analyses of daytime and nighttime urine (=basic collection) or analyses of urine samples collected every 3 h (=extended collection) extend this evaluation by describing circadian patterns of water and solute diuresis (=renal function profiles).