High incidence of nocturnal polyuria in women with overactive bladder

Introduction Treatment options for nocturia and nocturnal polyuria in women with overactive bladder (OAB) may differ, so it is critical to identify women at high risk for nocturnal polyuria
.

Research in this area is insufficient, so we conducted a study to assess the prevalence and predictors of nocturnal polyuria in women with OAB in Taiwan
.

The results were recently published in the World Journal of Urology
.

OAB seriously affects the quality of life of one in six women in the world
.

Its core symptoms are urgency, with or without urge incontinence, often accompanied by increased urinary frequency and nocturia
.

Frequent nocturia can cause women with OAB to get up too much at night, which can affect sleep quality, lead to more falls, and interfere with daytime activities
.

Nocturia is defined as the number of times an individual urinates during the main sleep time
.

Previous studies have confirmed that the incidence of nocturia increases with age, and people with nocturia symptoms account for more than half of the general population, indicating that nocturia is the most common symptom of lower urinary tract symptoms (LUTS)
.

In women with OAB, nocturia can be partially controlled with the use of nocturnal doses of antimuscarinic drugs
.

The 2019 International Continence Society (ICS) updated the concepts of nocturia and nocturnal lower urinary tract function
.

Nocturnal polyuria is defined as excessive urine production during an individual's primary sleep period
.

The definition of "excess" should be determined clinically based on the daily volume of urine produced by the patient's bladder
.

The nocturnal polyuria index (NPI) is the most common way to define nocturnal polyuria
.

Methods: From July 2009 to January 2018, a total of 4301 women with LUTS completed a 3-day voiding diary and underwent urodynamic and pad tests
.

A retrospective analysis of 1071 female patients with OAB was performed
.

The study included women over the age of 20 who had OAB symptoms for at least 3 months
.

The diagnostic criteria for OAB in female patients in this study were at least 3 months of subjective symptoms of urinary urgency and the presence of at least one urgency, stress-free incontinence (SUI) in the 3-day voiding diary
.

Dry OAB and wet OAB were differentiated based on a 3-day voiding diary
.

At least one diagnosis of acute urinary incontinence was wet OAB, otherwise dry OAB
.

Exclusion criteria included stress urinary incontinence, routine or intermittent self-catheterization, urinary tract infection or chronic inflammation in the previous 2 weeks, bladder stones, radical hysterectomy, or neurogenesis due to CNS injury Sexual bladder, history of pelvic radiotherapy, or pelvic malignancy
.

Patients with some underlying diseases and taking medication that caused nocturnal urination were also excluded
.

Nocturnal polyuria was diagnosed when patients met the following ICS criteria: (1) NPI >33% in women ≥65 years (2) NPI >20% in women <65 years In addition, women of all ages were diagnosed based on NPI >33% After nocturnal polyuria, the data were reanalyzed to study prevalence and predictors
.

Figure 1 Flowchart of the study Results: A total of 1071 women with OAB were included in the study, including 203 (19.
0%) women with wet OAB and 868 (81.
0%) women with OAB
.

Figure 2 shows the prevalence of nocturnal polyuria in women with OAB by age group
.

The overall prevalence was 30% (319/1071) according to the ICS criteria and 12% (128/1071) according to the "NPI33" criteria alone
.

According to ICS criteria, the highest prevalence was in perimenopausal women (46-50 years, 42/108, 38.
9%)
.

If the NPI33 criteria are used for diagnosis, the prevalence increases with age, and reaches the highest prevalence around the age of 80
.

Figure 2 The prevalence of nocturnal polyuria in different age groups The study analyzed the statistical data of 1071 patients, including age, reproductive status, wet OAB diagnosis, questionnaire survey, pad weight, urodynamic parameters and voiding diary parameters
.

Table 1 presents the results of univariate and multivariate analyses of nocturnal polyuria diagnosed by ICS criteria
.

The analysis results using NPI33 as the standard are shown in Table 2
.

In Table 1, univariate analysis revealed age (OR, 0.
99; 95% CI 0.
98–1.
00; p=0.
005), reproductive status (OR, 0.
85; 95% CI 0.
77–0.
93; p=0.
001), wet OAB (OR, 0.
68; 95% CI 0.
48–0.
97; p=0.
03), OABSS (OR, 1.
07; 95% CI 1.
02–1.
11; p=0.
004), IIQ-7 score (OR, 1.
03; 95% CI 1.
00–1.
06; p= 0.
04), strong desire to urinate (OR, 0.
997; 95% CI 0.
995–0.
999; p=0.
009), frequency of daytime voiding (OR, 0.
99; 95% CI 0.
98–1.
00; p=0.
04), and number of nocturia episodes (OR , 1.
30; 95% CI 1.
25–1.
36; p=0.
04) was the strongest predictor of nocturnal polyuria, and variables with p≤0.
05 were included in the multivariate analysis
.

Multivariate analysis revealed age (OR, 0.
98; 95% CI 0.
96–1.
00; p=0.
01), reproductive status (OR, 0.
82; 95% CI 0.
70–0.
97; p=0.
02), and daytime urination frequency (OR, 0.
93; 95% CI 0.
91–0.
95; p < 0.
001) and number of nocturia episodes (OR, 1.
51; 95% CI 1.
42–1.
62; p < 0.
001) remained strong predictors of nocturnal polyuria
.

The results of the ROC analysis revealed that more than 5 episodes of nocturia in the 3-day voiding diary were the cut-off values ​​for predicting nocturnal polyuria (sensitivity=85%, specificity=61%, area=0.
80, 95%Cl 0.
77-0.
82, see Fig.
3)
.

The areas under the curve for age, reproductive status and daytime frequency of voiding were 0.
57 (95%Cl 0.
53-0.
60), 0.
56 (95%Cl 0.
52-0.
60) and 0.
57 (95%Cl 0.
53-0.
61), respectively
.

Table 1 Predictive factor analysis (ICS criteria)Figure 3 ROC analysis under ICS criteria In Table 2, variable analysis revealed age (OR, 1.
03; 95% CI 1.
02–1.
05; p<0.
001), strong desire to urinate (OR, 1.
00; 95% CI 1.
00–1.
01; p=0.
02), frequency of daytime voiding (OR, 0.
96; 95% CI 0.
94–0.
98; p<0.
0001), and number of nocturia episodes (OR, 1.
27; 95% CI 1.
21–1.
33; p<0.
0001) 0.
001) was a strong predictor of nocturnal polyuria
.

Results of multivariate analysis revealed that only frequency of daytime voiding (OR, 0.
86; 95% CI 0.
83–0.
89; p < 0.
001) and number of nocturia episodes (OR, 1.
58; 95% CI 1.
46–1.
71; p < 0.
001) were more frequent at night.
predictors of uremia
.

The results of ROC analysis revealed that more than 5 episodes of nocturia in the 3-day voiding diary were the cut-off values ​​for predicting nocturnal polyuria (sensitivity=88.
3%, specificity=65.
9%, area=0.
83, 95%Cl 0.
80-0.
85, see Fig.
4)
.

The area under the ROC curve for daytime voiding frequency was only 0.
63 (95% CI 0.
60–0.
66)
.

Table 2 Predictive factor analysis (NPI33 criteria) Figure 4 ROC analysis under NPI criteria The relationship between the prevalence of nocturnal polyuria diagnosed by NPI criteria and the number of nocturia episodes is shown in Table 3
.

The prevalence of nocturnal polyuria increased significantly when the number of nocturia episodes in the 3-day voiding diary increased from 5 to 6, and from 1 to 2 per night
.

Table 3 Relationship between the prevalence of nocturnal polyuria and the number of nocturia episodes diagnosed by NPI criteria Conclusion Nocturia is more common in women with OAB, and patients with nocturia more than 5 times in the 3-day urination diary need adjuvant therapy to obtain more frequent nocturia.
good curative effect
.

Reference: Pei‑Chi Wu et, al.
Prevalence and predictors of nocturnal polyuria in females with overactive bladder syndrome.
World Journal of Urology (2022) 40:519–527.
Editor: LR Reviewer: XY Execution: LR