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Published on 19 April 2010

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Wake Up to Nocturia

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Study results discussed today at the European Association of Urology (EAU) Congress in Barcelona have reinforced the association between nocturia and a greater risk of falls and mortality.

In a population-representative study in Japan by Nakagawa et al, it was concluded that adults who suffered from nocturia (defined as two or more episodes of voids/urination per night) had a significantly increased risk of mortality when compared to adults without nocturia, even once adjustments had been made for other contributing factors (e.g. age, gender, physiological conditions).

Furthermore, a community-based study by Parsons et al in 5,872 men aged 65 years or above, showed that in adults with moderate or severe lower urinary tract symptoms (LUTS), the risk of having at least two falls significantly increased when compared to those with mild LUTS symptoms.

Adults who endured 2-3 awakenings per night due to a need for voiding, had a 21% greater risk of at least two falls, while adults who endured 4-5 awakenings due to voids per night had a 63% greater risk.[2] Nocturia was among the LUTS most strongly associated with falls.

“These studies have highlighted some vital new insights into nocturia, primarily that it is a serious medical condition that should not be dismissed as a lifestyle matter. The time has come for health providers and the public to give nocturia the attention it deserves,” comments Dr Raymond Rosen from the New England Research Institutes, USA.

Several studies have demonstrated that prevalence of nocturia is high with as many as 20% of adults aged 40-59 years thought to be affected.[3,4,5] This increases to approximately 35% in those over 60 years old.[3] Nocturia repeatedly disrupts sleep and is associated with multiple negative outcomes 0including a significant reduction in quality of life and an increased morbidity.[6] Interrupted sleep caused by nocturia not only affects the patient and their partners, but can also affect society through reduced productivity and job performance.

“The current lack of awareness about and understanding of nocturia means this major problem often remains undiagnosed or inappropriately treated,” comments Professor Philip Van Kerrebroeck from the University Hospital Maastricht, The Netherlands.

“In many cases, it is wrongly thought to be only a bladder or prostate problem, when nocturia may actually be a kidney problem. We need a two-pronged approach. Physicians need to recognise the signs and symptoms of the condition and treat it appropriately, but patients also need to be aware of the signs so they can go to their doctor as soon as they have any concerns. It is important for patients to understand that their condition can be treated and there is no need for them to suffer in silence”.

Further investigative study will be required to establish whether appropriate treatment of nocturia will help reduce the link between the condition and other chronic diseases.

In an effort to raise awareness of nocturia as a condition in its own right, it has newly been included within the official EAU guidelines. The new chapter on non-neurogenic lower urinary tract symptoms (LUTS), including nocturia, incorporates information on a variety of LUTS treatment options including alpha-blockers and 5-alpha-reductase inhibitors. The  chapter also highlights the role of desmopressin as the only therapy specifically addressing nocturia and its main cause nocturnal polyuria and awards a Level 1 Grade A recommendation.




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