Combination therapies for the management of nocturia and its comorbidities

Research and Reports in Urology Dovepress open access to scientific and medical research Review Research and Reports in Urology downloaded from https://www.dovepress.com/ by 60.53.214.97 on 27-May-2020 For personal use only. Open Access Full Text Article Combination therapies for the management of nocturia and its comorbidities This article was published in the following Dove Press journal: Research and Reports in Urology 20 April 2015 Number of times this article has been viewed Cenk Murat Yazici Omer Kurt Department of Urology, Namik Kemal University School of Medicine, Tekirdag, Turkey Introduction Correspondence: Cenk Murat Yazici Department of Urology, Namik Kemal University School of Medicine, 100. Yıl Mahallesi, Tunca Caddesi, 59100 Merkez/ Tekirda , Turkey Tel +90 506 855 2687 Fax +90 282 250 5001 Email Nocturia has become one of the most popular topics in urology in the last decade. It was thought to be a simple lower urinary tract symptom, but recent studies have confirmed the significance of this condition with regard to human health. The International Continence Society has defined nocturia as a complaint wherein the individual must wake up one or more times at night to void, independent of age, sex, causes, and associated bother. The main point of this definition was that nocturnal voids must precede and be followed by sleep.1,2 According to this definition, first morning voids should not be accepted as nocturia. This also distinguishes nocturia from nighttime frequency, defined as a number of night voids that are not related with sleep.2 Another terminological entity that should be distinguished from nocturia is nocturnal enuresis. In nocturia, patients are aware of having a full bladder and wake up to void, which is not the situation in nocturnal enuresis. Patients with nocturnal enuresis are not aware of their full bladders, and thus involuntarily empty their bladder into their beds. These terminological differences are key points for clinicians in differentiating several forms of nighttime voiding dysfunction. There is still no consensus about the frequency of nocturia. Although the International Continence Society classification used the term “one or more times,” some authors have reported the frequency of nocturia to be two or more episodes/night. For this reason, there have been different prevalence rates of nocturia in literature. In a recent meta-analysis, the prevalence of nocturia, which was defined as two or more 57 submit your manuscript | www.dovepress.com Research and Reports in Urology 2015:7 57–63 Dovepress © 2015 Yazici and Kurt. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/RRU.S51140 Powered by TCPDF (www.tcpdf.org) Abstract: Nocturia is the most bothersome lower urinary tract symptom. It has a multifactorial etiology. It had been thought nocturia was a nonspecific symptom of lower urinary system dysfunction, but it has been determined that many diseases, related to different organ systems, might be reasons for this nonspecific symptom. Along with the importance of systemic diseases that cause nocturia, the symptom itself has adverse effects on patients’ health and quality of life. There are several studies reporting a direct relationship between nocturia and depression, cognitive dysfunction, mood disturbances, falls, and fractures. For this reason, it is important to treat nocturia both to increase quality of life and to decrease related complications. Treatment opportunities have been under investigation for 20 years. Most of the studies in the literature have reported the results of single-drug medication on nocturia, which may be insufficient for a situation that has such a multifactorial etiology. In this review, we evaluated the success of different treatment combinations on nocturia. Keywords: nocturia, combination, treatment, polyuria, lower urinary tract symptoms Dovepress Research and Reports in Urology downloaded from https://www.dovepress.com/ by 60.53.214.97 on 27-May-2020 For personal use only. Yazici and Kurt episodes/night, has been reported as 2%–18% in the patients aged 20–40 years, increasing to 28%–62% by age 70 years.3 Nocturia occurring at least once a night was reported to be more prevalent in younger women than younger men, but the prevalence became similar in both sexes in older age groups.4,5 Regardless of the different definitions, there are two facts about the epidemiological properties of nocturia that remain constant: it is a common situation, and the prevalence rates increase with age. This age-dependent relationship has been shown in several epidemiological studies about nocturia.3–5 Risk factors and etiology of nocturia There are several etiological factors for nocturia, but the main pathophysiological mechanisms are related to four main issues: nocturnal polyuria, global polyuria, diminished nocturnal bladder capacity, and sleep impairment (Table 1). Different organ systems may take part in the formation of nocturia. Diseases related to the cardiovascular system (congestive heart disease), respiratory system (obstructive sleep apnea), urogenital system (renal dysfunction, detrusor overactivity, neurogenic bladder, etc), and psychosomatic Table 1 The pathophysiological factors and etiology of nocturia 1. Nocturnal polyuria a. Decrease in nocturnal vasopressin b. Increase in atrial natriuretic peptide c. Cardiac insufficiency, congestive heart failure d. Obstructive sleep apnea e. Diuretic usage (at evening) f. Lower extremity venous insufficiency   g. Evening polydipsia, alcoholism 2. Global polyuria a. Diabetes insipidus b. Diabetes mellitus c. Estrogen insufficiency in women d. Habitual polydipsia e. Renal insufficiency f. Hypercalcemia- and hypercalciuria-related diseases 3. Decreased nocturnal bladder capacity a. Detrusor overactivity b. Bladder outlet obstruction and related postvoidal residual urine c. Bladder hypersensitivity d. Urinary tract infection e. Bladder wall fibrosis f. Bladder tumor, stone, or foreign body   g. Interstitial cystitis h. Postsurgical bladder dysfunction 4. Sleep disturbances a. Environmental impairments b. Anxiety disorders c. Depression d. Stimulant usage e. Melatonin deficiency of aging 58 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress system (anxiety disorders, depression) may be a reason for nocturia. Patients’ medical treatments for their comor (...truncated)