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Nocturia
Definition of Nocturia
The International Continence Society defines Nocturia as a complaint that the individual has to wake at night one or more times to void (Kerrebroeck et al., 2002) (Weiss, 2006)..
Differential Diagnosis of Nocturia
Nocturia due to General Polyuria:
- Diabetes mellitus
- Diabetes insipidus
- (Psychogenic) polydipsia
Nocturia due to Nocturnal Polyuria:
- Disorder of the circadian vasopressin secretion in the elderly.
- Right-sided heart failure: increased wall tension of the right atrium through the horizontal sleeping position leads to an increased release of ANF (atrial natriuretic peptide) and thus to fluid secretion. In addition, fluid from the lower extremities (leg edema) is returned again to the blood stream at night.
- Sleep apnea: hypoxia during the night leads to pulmonary vasoconstriction, this causes an increased wall tension of the right atrium and the release of ANF.
- Diuretics given in the evening
Nocturia due to Reduced Bladder Capacity:
- Advanced bladder cancer
- Advanced prostate cancer
- Radiation cystitis
- Bladder pain syndrome or interstitial cystitis
- Tuberculosis of the bladder
Nocturia due to Reduced Functional Bladder Capacity:
- Residual urine (subvesical obstruction or neurogenic lower urinary tract dysfunction)
- Bladder stones
Pharmacological causes of nocturia:
Diuretics, beta-blocker, theophylline or caffeine, especially when taken in the evening.
Nocturia due to Detrusor Instability:
- Neurogenic lower urinary tract dysfunction
- Overactive bladder
- Bladder inflammation
- Distal ureteral stone
Diagnostic Workup of Nocturia
- Micturition diary: helps to differentiate between nocturnal polyuria (night time urine volume inclusive the first morning micturition) or reduced bladder capacity.
- Residual urine
- Urine flow to check for subvesical obstruction
- Urodynamics in cases with neurogenic or unclear micturition disorders
- Medical evaluation in nocturnal polyuria and heart or lung disease.
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References
van Kerrebroeck, P.; Abrams, P.; Chaikin, D.; Donovan, J.; Fonda, D.; Jackson, S.; Jennum, P.; Johnson, T.; Lose, G.; Mattiasson, A.; Robertson, G.; Weiss, J. & of the International Continence Society The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society.Neurourol Urodyn, 2002, 21, 179-183.
Weiss, J. P. Nocturia: "do the math".
J Urol, 2006, 175, S16-S18
Deutsche Version: Nykturie