The clinical features of nocturnal enuresis in adult men and women / 中华泌尿外科杂志

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

Circadian Rhythm of ADH, Hypercalciuria, and Solute Diuresis as Pathogenesis of Enuresis

Nocturnal polyuria is one of the main pathogenic mechanisms of enuresis. Disturbance of circadian rhythm of antidiuretic hormone (ADH or AVP), hypercalciuria, and/or solute diuresis are considered to cause nocturnal polyuria, which in turn causes enuresis in patients with relatively small bladder capacity and high threshold for awakening. Evaluation of these factors would guide the therapeutic approach for enuresis.

Desmopressin is an Effective Treatment for Mixed Nocturia with Nocturnal Polyuria and Decreased Nocturnal Bladder Capacity

To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged > or =18 yr with mixed nocturia (> or =2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4+/-44.1 to 220.3+/-90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.

Nocturnal Polyuria Developed in Patients with Central Pontine Myelinolysis: A case report

Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin.

The Etiology and Classification of Nocturia in Adults / 대한비뇨기과학회지

PURPOSE: Nocturia, from which the patients feel the most discomfort, is one of the frequently complained urologic symptoms combined with insomnia. Studying the etiology and classification of nocturia is not enough. In this study, we analyzed the voiding diary and urodynamic study to investigate the etiology of nocturia. We classified the type of nocturia based on the etiology. MATERIALS AND METHODS: We reviewed the urodynamic study (UDS) as well as the three days voiding diary of 152 patients with nocturia. We classified nocturia into three groups based on the voiding diaries and the results of UDS: Pure nocturnal polyuria in which the voided urine volume during the hours of sleep is more than 35% of the 24-hours urine volume, detrusor overactivity defined as existing uninhibited contraction on filling cystometrogram, and mixed (nocturnal polyuria with detrusor overactivity). Polyuria (24-hours urine output >2,500cc) was classified separately. RESULTS: The mean number of nocturia was 3.3 (3.1 for men, 3.4 for women). octurnal polyuria, detrusor overactivity and mixed were 50.0%, 7.9% and 17.1% respectively. Nocturnal polyuria was not related with detrusor overactivity, bladder outlet obstruction and impaired detrusor contractility, but significantly increased with age (p<0.01) and in men (p<0.05). Detrusor overactivity was not related to impaired detrusor contractility, but was significantly related to the bladder outlet obstruction (p<0.05) and increased with age (p<0.01) and in men (p<0.01). Seventeen (11.2%) had polyuria. CONCLUSIONS: In 75% of nocturia patients, there were nocturnal polyuria, detrusor overactivity or mixed type and 11.2% of them had polyuria. Therefore we conclude that these three causes were the main etiology of nocturia, and nocturia could be classified and treated based on these results.

The Relation between Nocturnal Polyuria and Diurnal Variation of the ADH in Patients with Cervical Cord Injury

OBJECTIVE: It was reported that nocturnal polyuria in cervical cord injured patients may be due to attenuation of diurnal variation of antidiuretic hormone (ADH) level. However, it has been unclear whether the attenuation of diurnal variation of ADH level caused nocturnal polyuria and bladder overdistension. To improve the management of neurogenic bladder with overdistension during the night, we investigated whether the attenuation of diurnal variation of ADH level is the cause of nocturnal polyuria or bladder overdistens-ion in patients with cervical cord injury. METHOD: The subjects consisted of 17 patients with cervical cord injury. The age distribution ranged from 31 to 63 years with an average of 41.5 years. The duration of illness ranged from 5 months to 4 years. Oral intake was restricted below 2,000 ml per day. We measured urine volume and urine osmolarity during the day (8 AM~8 PM) and night period (8 PM~8 AM) and the level of plasma ADH and serum osmolarity at 2 PM and 2 AM. RESULTS: Plasma ADH level was 0.81+/-0.51 pg/ml during the day and 1.04+/-0.65 pg/ml during the night (p=0.17). Urine volume was 1050+/-410 ml during the day and 970+/-550 ml during the night (p=0.92). The average of urine osmolarity was 450.4+/-182.8 mosm during the day and 558.4+/-359 mosm during the night (p=0.25). The average of serum osmolarity was 292.4+/-14.5 mosm during the day and 290.4+/-9.3 mosm during the night (p=0.53). CONCLUSION: This study showed that there was no significant difference in each parameter for two periods and urine volume was not increased in spite of attenuation of diurnal variation of ADH level. Therefore this indicated that attenuation of diurnal varia-tion of ADH was less likely responsible for nocturnal polyuria in patients with cervical cord injury.

Relationship between Nocturnal Polyuria and Antidiuretic Hormone in Chronic Spinal Cord Injury

OBJECTIVE: To delineate the role of antidiuretic hormone (ADH) in relation to nocturnal polyuria, and to identify the factors influencing on the diurnal antidiuretic hormone level. METHOD: The ADH was measured by radioimmuoassay at daytime (2:00 PM) and at nighttime (2:00 AM) with nocturnal polyuria group (11) and without nocturnal polyuria group (8). Urine volume, serum osmolarity, urine osmolarity, and blood pressure were also measured at the same time. RESULTS: 1) The ADH at 2:00 AM did not increase in nocturnal polyuria group, although it increased in no-symptom group. 2) There was a statistically significant correlation between wheelchair ambulation time and daytime ADH level. 3) The difference of ADH level between daytime and nighttime showed decrease in orthostatic hypotension group. CONCLUSION: There was relationship between nocturnal polyuria and diurnal variation of ADH level. The ADH concentration seems to be influenced by the postural factors and sympathetic factors.

Diurnal Variation of Plasma Anti-Diuretic Hormone and Relationship to Nocturnal Polyuria after Spinal Cord Injured Patients

OBJECTS: To investigate the effect of anti-diuretic hormone (ADH) on nocturnal polyuria in spinal cord injured patients. METHODS: Eleven quadriplegics, seven paraplegics, and nine normal person participated in this study. Quadriplegics and paraplegics ranged from A to C grades according to the ASIA classification. All participants were independent in activities of daily living on wheelchair level. Their intake and output were measured at every 6 hours for 24 hours. The level of ADH was measured by the radioimmunoassay method. RESULTS: 1) Urine output from midnight to 6:00 A.M. was increased in quadriplegics, but not in paraplegics. 2) ADH at 6:00 A.M. and midnight was decreased in quadriplegics than in controls. No significant change of ADH level was noted in paraplegics. 3) Serum osmolality was higher in quadriplegics than in controls at 6:00 A.M. and midnight. CONCLUSION: This study indicates that the nocturnal polynuria in spinal cord injured patient is partly due to a decreased ADH.