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Diagnosis of Nocturia

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					Diagnosis of Nocturia




     Prof.Dr. Mohamed shafik
                           Definition
• The International Continence Society (ICS) defines
  nocturia as “the complaint that the individual has to
  wake at night one or more times to void.”.

• Previous definitions that have been used included ≥ 2
  voids or ≥ 3 voids per night.

• It is among the common reasons for persistent
  insufficient sleep, which in turn is responsible for
  psychological and somatic disease.

 Abrams P et al: The standardisation of terminology in lower urinary tract function Society.
                                   Urology 61: 37–49, 2003
  men (red)



women (green)




                     Prevalence of nocturia
                Because the frequency of nocturia increases with age,

    the prevalence of the condition is naturally greater in the elderly population   .
STANDARDIZATION AND TERMINOLOGY OF
             NOCTURIA
CAUSES OF NOCTURNAL POLYURIA
COMMON CAUSES OF LOW NOCTURNAL
       BLADDER CAPACITY
Causes of Nocturnal polyuria
                 Nocturia
• Each void must be preceded and followed by
  sleep, i.e., the first morning void is not included
• It is independent of the trigger for waking
• It depends on the time spent sleeping and not
  on the time spent in bed, i.e., it does NOT
  include:
   – voids after going to bed but before going to sleep
   – voids that prevent going back to sleep
     Diagnosis: detailed history
• The diagnostic approach to nocturia should start with a
  detailed history and a thorough medical evaluation.

• Patients should be screened for various conditions that
  can contribute to the presence of nocturia including:
   Neurologic abnormalities
   Voiding symptoms
   Diabetes mellitus
   Hypertension
   History of surgery of the lower urinary tract.
   Sleep disorders
   Medications such as diuretics and calcium antagonists,
   Timing and amount of fluid intake
   Congestive heart failure
   Menopausal symptoms
Diagnosis: physical examination

• During physical examination, patients should be
  screened for edema, oestrogen status, age-related
  changes of the genitalia, pelvic mass and prolapse.

• Neurologic examination should include evaluation of
  anal sphincter tone, the bulbocavernosus reflex, and
  sensation in the sacral dermatomes.


• Cardiovascular system examination.
                Voiding diary
• The principal diagnostic tool for use in the
  assessment of nocturia is the voiding bladder diary.

• On the basis of the voiding diary,the patient is
  categorized as having polyuria, nocturnal polyuria,
  low nocturnal bladder capacity or a mixed disorder.

• Information that should be collected and recorded in
  the voiding bladder diary includes timing of voids,
  number of voids, and volume of urine voided. Fluid
  intake volume and time of fluid intake should also be
  recorded
 Quality of life questionnaire ,e.g., ICIQ-N
Intended to be:
• Self-completion questionnaire to assess the symptom
   of nocturia and its impact
• Universal and condition-specific
• Applicable to a wide range of individuals of adult men
   and women
• Comprehensive and psychometrically robust
• Of use in epidemiological and outcomes research as
   well as routine clinical practice
• Short and simple with two symptom questions
   – daytime and night-time urination
   – QoL assessed
• Recommended add-on module
   – ICIQ-NQoL (13 questions)
       Diagnostic algorithm
                NOCTURIA


           Bother            No Bother
                                               No Presentation
             Patient Presents

                    Screen
                              Advice

            Further Evaluation



Polyuria    Nocturnal Polyuria           Apparent Bladder
                                         Storage Problems


                        Other Classification       Primary Sleep Disorder
                                              Bothersome Nocturia
                    MEDICAL HISTORY
                    • Other urinary tract symptoms/ Sleep history/ Drinking habits (quantity and
                    type)/ Medication (e.g., diuretics)
History/Clinical    EXAMINATION
                    • Ankle oedema/Abdominal examination/Prostate assessment/Female pelvic
 Assessment
                    assessment/Assess post-void residual urine
                    INVESTIGATIONS
                    • Urinalysis – if infected, treat and reassess


                                               Frequency Volume Chart


                   GLOBAL POLYURIA (24h          NOCTURNAL POLYURIA            OTHER AETIOLOGY
  Presumed         voided volume >40 ml/kg)      (nocturnal urine volume       • Overactive bladder
  Diagnosis        • Electrolytes                >22 – 33% of total 24h        • Bladder outflow obstruction
                   • Serum glucose               urine volume (age             • Sleep disturbance
                                                 dependent)                    • Cardiac disease
                                                                               • Gynaecological abnormality
                                                       Lifestyle advice        • Bladder pain or bleeding
                    Lifestyle advice

                                                       Non-responders
 Treatment                                                                        Further evaluation and
                                                                                  appropriate treatment
                                              • Desmopressin bed-time
                    Non-responders            • Furosemide in the afternoon

                                                       Non-responders                 Non-responders


                                                      Specialist referral
Thank You

				
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