Comparison of nocturia etiology in black and white male patients.

INTRODUCTION: Much of what is known about the etiology of nocturia (i.e., nocturnal polyuria [NP], small bladder capacity [SBC], etc.) at the population level stems from the Krimpen study, which enrolled aging males from a homogenous municipality in the Netherlands. Given the higher prevalence of benign prostatic hyperplasia and overactive bladder in black versus white males in population research, we aim to test the hypothesis that black males seeking treatment for lower urinary tract symptoms (LUTS) are more likely to have nocturia owing to SBC. MATERIALS AND METHODS: We retrospectively analyzed 24 hour frequency-volume charts (FVCs) completed by males seeking treatment for LUTS at a Veterans Affairs urology clinic from 2008-2016. Patients were included if they were ≥ 18 years, identified as either Caucasian or African American, and had a complete baseline FVC showing ≥ 1 nocturnal void. Patients were stratified by race and classified as having nocturia owing to SBC (defined by a maximum voided volume < 200 mL or a nocturnal bladder capacity index > 1.3); NP (defined by a nocturnal polyuria index > 0.33); 'mixed' (SBC + NP); or 'other' (neither SBC nor NP). RESULTS: Between white and black patients, 28 (24%) versus 28 (26%) had NP, 32 (27%) versus 33 (30%) had SBC, and 35 (30%) versus 30 (28%) had mixed nocturia. Overall, there was no difference in distribution of underlying etiology by race (p = 0.51). CONCLUSIONS: Our results demonstrate no difference in the etiology of nocturia between black and white males. Accordingly, race should not play a role in the evaluation of patients seeking treatment for nocturia.

Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years.

Background Hypertension is assumed to be asymptomatic. Yet, clinically significant nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to nocturia because of blunted nocturnal blood pressure ( BP ) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to nocturia. Here, we test the hypothesis that nocturia is a common and potentially reversible symptom of uncontrolled hypertension in black men. Methods and Results We determined the strength of association between nocturia (≥2 nightly voids) and high BP (≥135/85 mm Hg) by conducting in-person health interviews and measuring BP with an automated monitor in a large community-based sample of black men in their barbershops. Because nocturia is prevalent and steeply age-dependent after age 50 years, we studied men aged 35 to 49 years. Among 1673 black men (mean age, 43±4 years [ SD ]), those with hypertension were 56% more likely than men with normotension to have nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95% CI , 1.25-1.94 [ P<0.0001]). Nocturia prevalence varied by hypertension status, ranging from 24% in men with normotension to 49% in men whose hypertension was medically treated but uncontrolled. Men with untreated hypertension were 39% more likely than men with normotension to report nocturia ( P=0.02), whereas men whose hypertension was treated and controlled were no more likely than men with normotension to report nocturia ( P=0.69). Conclusions Uncontrolled hypertension was an independent determinant of clinically important nocturia in a large cross-sectional community-based study of non-Hispanic black men aged 35 to 49 years. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unqiue identifier: NCT 02321618.

Bladder Symptoms and Attitudes in an Ethnically Diverse Population.

OBJECTIVE: The aim of the study was to assess pelvic floor symptoms and attitudes in an ethnically diverse population. METHODS: We conducted a cross-sectional survey of women presenting to 2 community-based, ethnically diverse gynecology clinics. Before being seen by a provider, participants were asked to complete a questionnaire. RESULTS: A total of 312 women were included: 32.7% white, 50.3% African American, and 17.0% Hispanic. Other racial/ethnic groups were excluded secondary to small samples size. The median (interquartile range) age was 34.0 (27.0-44.0) years. The groups differed with respect to most demographic characteristics, such as income, education, and nation of origin. Nocturia and urinary frequency were the most commonly reported symptoms. African American respondents were more likely to report nocturia than white respondents (odds ratio, 2.4; 95% confidence interval, 1.2-4.8). Respondents' views of normal urinary function generally did not vary by race/ethnicity. However, Hispanic respondents were less likely than white respondents to agree that it is normal to leak urine after having children (odds ratio, 0.28; 95% confidence interval, 0.11-0.68). Among women who reported at least 1 symptom, 46.7% reported that at least 1 symptom bothered them, and this did not differ with respect to race/ethnicity (P ≥ 0.59). African American respondents were more likely than whites to report their urinary leakage to their doctors (P = 0.006). CONCLUSIONS: Our study demonstrates that with few exceptions, bladder symptoms and attitudes are similar among reproductive-age women of various racial/ethnic groups in a community setting.

The burden of nocturia among middle-aged and older women.

OBJECTIVE: To examine the prevalence, predictors, and effects of nocturia in women and evaluate overlaps with established urinary tract disorders. METHODS: This was a cross-sectional analysis of 2,016 women, aged 40 years and older, recruited from Kaiser Permanente Northern California from 2008 to 2012. Nocturia and other urinary symptoms were assessed using structured interviewer-administered questionnaires. Nocturia was defined as patient-reported nocturnal voiding of two or more times per night over a typical week. RESULTS: Thirty-four percent (n=692) reported nocturia, and 40% of women with nocturia reported no other urinary tract symptom. Women with nocturia were older (mean age 58 compared with 55 years) (odds ratio [OR] per 5-year increase 1.21, 95% confidence interval [CI] 1.12-1.31), more likely black (45%) (OR 1.75, 95% CI 1.30-2.35) or Latina (37%) (OR 1.36, 95% CI 1.02-1.83) compared with non-Latina white (30%), have worse depression (mean Hospital Anxiety and Depression Scale score 3.8 compared with 2.8) (OR per 1-point increase in Hospital Anxiety and Depression Scale score 1.08, 95% CI 1.04-1.12), and worse mobility (mean Timed Up-and-Go 11.3 compared with 10 seconds) (OR per 5-second increase in Timed Up-and-Go 1.29, 95% CI 1.05-1.58). Nocturia occurred more among women with hysterectomy (53% compared with 33%) (OR 1.78, 95% CI 1.08-2.94), hot flushes (38% compared with 32%) (OR 1.49, 95% CI 1.19-1.87), and vaginal estrogen use (42% compared with 34%) (OR 1.50, 95% CI 1.04-2.18). CONCLUSION: Nocturia is common in women and not necessarily attributable to other urinary tract disorders. Factors not linked to bladder function may contribute to nocturia risk, underlining the need for multiorgan prevention and treatment strategies. LEVEL OF EVIDENCE: II.

Efficacy of fesoterodine on nocturia and quality of sleep in Asian patients with overactive bladder.

OBJECTIVE: To investigate the efficacy of fesoterodine vs placebo on nocturia, sleep disturbance, and sleep-related quality of life (QoL) in patients with overactive bladder and nocturia. METHODS: This posthoc analysis used data from a 12-week, randomized, placebo-controlled trial of fesoterodine 4 and 8 mg per day in Asian adults reporting ≥8 micturitions and ≥1 urgency urinary incontinence episodes per 24 hours at baseline. Patients who reported ≥1 nocturnal micturition/24 h were included in this analysis. Efficacy variables included change from baseline to week 12/end of treatment in nocturnal micturitions/24 h, nocturnal voided volume/micturition, and hours of undisturbed sleep. Sleep-related QoL was assessed using King's Health Questionnaire Sleep/Energy domain. Treatment comparisons were made using analysis of covariance. RESULTS: Among 555 patients, reductions in nocturnal micturitions with fesoterodine 4 mg (-0.63) and 8 mg (-0.77) were numerically greater vs placebo (-0.56), but differences were not significant (P >.05). When patients with a nocturnal polyuria index >33% were excluded, the decrease in nocturnal micturitions was significantly greater with fesoterodine 8 mg vs placebo (-0.24; P = .031). Increases in nocturnal voided volume/micturition were significantly greater with fesoterodine 4 (38.07 mL; P = .013) and 8 mg (42.05 mL; P <.001) vs placebo (14.89 mL). Hours of undisturbed sleep was significantly longer with fesoterodine 4 mg vs placebo (80 vs 54 minutes; P = .032); improvement in King's Health Questionnaire Sleep/Energy scores was significantly greater with fesoterodine 4 (P = .034) and 8 mg (P = .019) vs placebo. CONCLUSION: These results suggest that fesoterodine may reduce nocturnal micturitions and improve sleep quality and QoL in overactive bladder patients with nocturia.

Prevalence of nocturia in Parkinson's disease patients from various ethnicities.

OBJECTIVES: One of the most common non-motor symptoms in Parkinson's disease (PD) is nocturia. This paper seeks to address the prevalence of nocturia in PD and correlate it to various factors such as gender, Hoehn and Yahr (H&Y) stage, age, and ethnicities. METHODS: In particular, 332 PD patients were seen in a community movement disorders clinic and their charts were analyzed from 2005 to 2010. Within this population, more than one-third (34.9%) patients were diagnosed with nocturia. RESULTS: Age, gender, and PD stage were significant predictors of nocturia in PD. With every one-year increase in age, the odds of developing nocturia in PD increases by 3.1% while an increase in H&Y stage increases the odds of nocturia in PD by 1.645 times. Also, males had greater odds of experiencing nocturia in PD. Ethnicities alone were of no significant importance. However, after performing interaction analyses, Asian and Indian males, especially, were at significantly greater risk than other ethnicities. DISCUSSION: Future research is indeed required to understand why certain ethnicities are especially at risk. Clinicians must also be aware of the epidemiology of nocturia in PD to prevent and treat this debilitating symptom.

B-type natriuretic peptide as an independent correlate of nocturnal voiding in Japanese women.

AIMS: To investigate whether objective cardiovascular parameters have an independent association with nocturnal voiding in women. METHODS: Thirty-two parameters derived from questionnaires, and anthropometric, physiological and biochemical measures of 5,980 women were applied for analysis. Nocturnal voiding was assessed by the International Prostate Symptom Score and the Overactive Bladder Symptom Score. We measured variables including previously reported correlates of nocturnal voiding, such as age, a history of hypertension, and a history of diabetes, as well as those focusing on cardiovascular function, such as the cardio-ankle vascular index, the augmentation index, the ankle-brachial index, plasma B-type natriuretic peptide (BNP), and C-reactive protein (CRP). RESULTS: Age [odds ratio (OR): 1.058, P < 0.001], length of sleep (OR: 1.194, P < 0.001), sleeplessness (OR: 2.841, P < 0.001), urgency (OR: 1.528, P < 0.001), log(BNP) (OR: 2.031, P < 0.001), waist circumference (OR: 1.037, P = 0.002), body mass index (OR: 0.935, P = 0.007), menopause (OR: 1.503, P = 0.043), and history of hypertension (OR: 1.225, P = 0.029) were independently associated with nocturnal voiding ≥2 times. Age (ß = 0.256, P < 0.001), urgency (ß = 0.195, P < 0.001), sleeplessness (ß = 0.181, P < 0.001), length of sleep (ß = 0.088, P < 0.001), log(BNP) (ß = 0.072, P < 0.001), waist circumference (ß = 0.086, P < 0.001), and low-density lipoprotein-cholesterol (ß = -0.038, P = 0.003) were significantly correlated with the severity of nocturnal voiding. CONCLUSIONS: Plasma BNP, which represents cardiac load, is strongly associated with the prevalence and severity of nocturnal voiding in Japanese women, as well as previously known correlates including age, urgency, quality and quantity of sleep, and obesity.

Impact of ethnicity on non-motor symptoms of Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative illness characterized by various non-motor symptoms that may contribute to disability, impaired quality of life and shortened life expectancy. The aim of present study was to determine the relative prevalence of common non-motor symptoms in various ethnic groups. A retrospective chart analysis was performed on Parkinson's disease patients where a total of 314 PD patients from six ethnic categories were examined for the occurrence of anxiety, visual hallucinations, nocturia, drooling and dementia. Our results show that anxiety in PD patients was correlated with their ethnicity classification. Interesting trends were observed with respect to nocturia and dementia symptoms and no significant differences were found between ethnic groups for visual hallucinations and drooling. Our study shows that non-motor symptoms of Parkinson's disease are prevalent across all ethnic groups, and except anxiety there may not be any impact of ethnicity on dementia, nocturia, drooling, and visual hallucinations.

Prevalence and risk factors of nocturia and nocturia-related quality of life in the Chinese population.

OBJECTIVES: To evaluate the prevalence, risk factors of nocturia and nocturia-related quality of life. METHODS: Age, hypertension, cardiovascular disease, diabetes mellitus, benign prostatic hyperplasia (BPH), alcohol abuse and smoking were analyzed using logistic analysis. Multiple linear-regression analysis was used to identify factors predicting the score on the Nocturia Quality of Life (N-QOL) questionnaire. RESULTS: 1,198 adults completed this study. 411 individuals (34.3%) answered that they arose for urination at least twice during the night. The incidence of nocturia increased with age from 8.6% in individuals younger than 40 to 67.7% in those older than 70. Hypertension [odds ratio (OR) 2.322; 95% confidence interval (95% CI): 1.387-3.887] and diabetes (OR 2.298; 95% CI: 1.066-4.954) were possible risk factors for nocturia. In male individuals, BPH (OR 3.900; 95% CI: 1.890-8.049) was another risk factor. Gender was not found to be associated with nocturia. Increasing episodes of nocturia (regression coefficient: -2.564; 95% CI: -3.08 to -2.049) and decreasing total sleeping hours (regression coefficient: 1.738; 95% CI: 0.948-2.527) were independent factors predicting a significantly lower N-QOL score. CONCLUSIONS: Hypertension, diabetes and BPH are associated with nocturia, suggesting that multiple approaches are needed when treating patients with nocturia. Nocturia has a significant impact on the nocturia-related quality of life when the patient has 2 or more episodes per night.

Are racial/ethnic disparities in the prevalence of nocturia due to socioeconomic status? Results of the BACH survey.

PURPOSE: Racial/ethnic disparities in nocturia prevalence have been reported previously. We estimated nocturia prevalence rates by race/ethnicity and determined the contribution of socioeconomic status to potential differences by race/ethnicity. MATERIALS AND METHODS: The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,501 adults, including 2,301 men and 3,200 women, who were 30 to 79 years old. Nocturia was defined as voiding more than once per night in the last week or voiding more than once per night fairly often, usually or almost always in the last month. Self-reported race/ethnicity was defined as black, Hispanic and white. Socioeconomic status was defined as a combination of education and household income. RESULTS: The overall prevalence of nocturia was 28.4% with a higher prevalence in black and Hispanic participants compared to white participants (38.6% and 30.7%, respectively, vs 23.2%), a trend that was consistent by gender. After adjusting for socioeconomic status the increased odds of nocturia in Hispanic men disappeared (adjusted OR 1.04, 95% CI 0.71, 1.52), while the OR in black men was attenuated but remained statistically significant (OR 1.57, 95% CI 1.12, 2.21). In women the association between race/ethnicity and nocturia was attenuated but remained statistically significant after adjusting for socioeconomic status. CONCLUSIONS: Socioeconomic status accounts for part of the racial/ethnic disparities in prevalence of nocturia. The effect of socioeconomic status was more pronounced in men and in Hispanic participants, while differences in nocturia prevalence remained significant in black men and women.

Nocturia, nocturia indices and variables from frequency-volume charts are significantly different in Asian and Caucasian men with lower urinary tract symptoms: a prospective comparison study.

OBJECTIVE: To describe and compare the patterns of nocturia in Asian and Caucasian men presenting with lower urinary tract symptoms (LUTS), and to identify associations or correlations between LUTS and variables from a frequency-volume chart (FVC), as nocturia is common among men with LUTS, and analysis of FVCs shows nocturnal polyuria and reduced nocturnal bladder capacity (NBC) as the predominant causes in Western patients, but there are few comparisons with other ethnic groups. PATIENTS AND METHODS: Consecutive men aged > or = 40 years, presenting with LUTS and nocturia to an Asian and a Caucasian tertiary centre, were recruited prospectively. The men completed the International Prostate Symptom Score and a 3-day FVC. Men having had bladder outlet surgery and/or receiving anticholinergics were excluded. We computed the nocturia ratio, i.e. the nocturnal urine volume/ 24-h urine volume, nocturia index, predicted nocturnal voids and NBC index (NBCI), and analysed comparisons and correlations. RESULTS: In all, 93 Asian and 200 Caucasian men were recruited prospectively, with a similar age and overall severity of LUTS. The nocturia ratio was larger in the Caucasian men, whereas the NBCI was larger in the Asians (P < 0.001). The prevalence of nocturnal polyuria in men aged > or =60 years (nocturia ratio > or =0.3) was significantly higher in the Caucasian population. Conversely, the prevalence of reduced NBC appeared to be higher in the Asians (based on a NBCI of >2; P < 0.001). CONCLUSIONS: The patterns of nocturia and FVC variables differed significantly in age-matched Asian and Caucasian groups. There are also possible ethnic differences in the causes of nocturia, with nocturnal polyuria being more prevalent in Caucasians.