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FREE: Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

FREE: Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Teaser: 

1Dean Elterman, MD, FRCSC, 2Co-authors: Brandon Van Asseldonk B. Eng

1Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON

2Faculty of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Nocturia is a common urologic condition with prevalence increasing in the elderly and can result in fragmented sleep, impaired daytime functioning, and falls. It can be a symptom of BPH or OAB but is commonly multifactorial with fluid intake, sleep apnea, and diabetes contributing. Nocturia is often a result of nocturnal polyuria which is best diagnosed by recording voiding frequency and volumes. Treatment is driven by patient symptoms and reported level of bother, with first-line therapy being lifestyle modification and second-line therapy being desmopressin (Nocdurna).
Key Words: Nocturia, Nocturnal Polyuria, Nocdurna, Desmopressin.

Nocturia is a common urologic condition, particularly in elderly populations.
Nocturia, or waking twice or more during the night to void, can cause fragmented sleep and can impair function during the day.
It is essential that primary care physicians and specialists diagnose nocturia because it can lead to poor health, including conditions like: an increased risk of falls and accidents, cardiovascular disease, diabetes, depression, and increased morbidity and mortality.
A thorough history will aid in the diagnosis of nocturia.
Lifestyle modifications, including: timed voiding, dietary and fluid restrictions, medication timing, sleep hygiene, and evening leg elevation can provide some relief for nocturia patients.
Second-line treatment is the use of desmopressin, an antidiuretic that can reduce the number of nighttime voids and thus improve sleep, particularly in women.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is only $20 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Disclaimer: 

This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource.
The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

FREE: Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

FREE: Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Teaser: 

Dean Elterman, MD, FRCSC, Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON.

This supplement provides an overview of nocturia, its impact on patients and various treatment options available to the general practitioner. Nocturia is a common condition, whereby patients are awakened from sleep with the need to urinate. Typically associated with older patients, it can also occur in younger populations. It is often underreported and attributed to aging by patients, indicating the importance of screening by physicians.

Its causes are numerous and multisystem in nature, including congestive heart disease, kidney dysfunction, diabetes and nocturnal polyuria – an over production of urine at night. Nocturia is a lower urinary tract symptom, and may be seen with several common urologic conditions such as overactive bladder and benign prostatic hyperplasia.

Nocturia is particularly important because of its impact on quality of life. Frequently waking to pass urine can leave patients chronically fatigued and sleep deprived, leading to impairment during the day and at work. For those at risk of falls and fractures it can be a cause, especially with poor visibility at night. Patients who are unable to make it to the washroom urgently may experience episodes of incontinence during the night. As a possible symptom of many different diseases, nocturia may be the presenting complaint that prompts further investigations and eventually leads to a diagnosis and treatment. It may be associated with other urinary tract conditions including infection and inflammation. Its diagnosis is equally important because of available treatments for either the underlying disease or for nocturnal polyuria—a common cause of nocturia.

This publication focuses on nocturnal polyuria as a common and treatable cause of nocturia. Diagnosis of nocturnal polyuria is made via history, physical exam and frequency-voiding charts. Treatment is tailored to the degree that the patient is symptomatic and begins conservatively with reduction in fluid intake (alcohol and caffeine) before bed, timed voiding and sleep hygiene. Many patients are unaware of the impact that their habits have on nocturia, and simple changes may be very effective.

Medical management involves desmopressin taken as an oral disintegrating tablet before bed which acts as an antidiuretic hormone to reduce urine production overnight in a short acting manner. Newer formulations have significantly lower rates of hyponatremia which must be measured before initiating therapy.

Disclaimer: 
This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource. The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

La nycturie et la polyurie nocturne : ce qui garde les urologues éveillés la nuit

La nycturie et la polyurie nocturne : ce qui garde les urologues éveillés la nuit

Teaser: 

1Dr Dean S. Elterman, M.D., M.Sc., FRCSC,2Coauteur : Brandon Van Asseldonk B.A.Sc.

1chirurgien urologue titulaire, Toronto Western Hospital, University Health Network; professeur adjoint, division d'urologie, département de chirurgie, université de Toronto, Toronto (Ont.).

2Faculté de médecine, université de Toronto, Toronto (Ont.).

OUTILS CLINIQUES

Résumé : La nycturie est un trouble urologique fréquent qui peut provoquer un sommeil fragmenté, une perturbation des capacités fonctionnelles dans la journée et des chutes. Sa prévalence est plus forte chez les personnes âgées. Elle peut être un symptôme d'hyperplasie bénigne de la prostate (HBP) ou de vessie hyperactive (VH), mais elle est fréquemment d'origine multifactorielle, par exemple en raison de l'apport liquidien, d'une apnée du sommeil et d'un diabète. La nycturie résulte souvent d'une polyurie nocturne (PN), que l'on diagnostique le mieux en notant la fréquence et le volume des mictions. Le traitement repose sur les symptômes des patients et sur le niveau de gêne signalé. Le traitement de première intention correspond à des modifications du mode de vie, et le traitement de deuxième intention est la desmopressine (Nocdurna).
Mos clés : Nycturie, polyurie nocturne, Nocdurna, desmopressine.

La nycturie est un trouble urologique fréquent, qui affecte notamment un grand nombre de personnes âgées.
La nycturie, ou le fait de se réveiller plus de deux fois par nuit pour uriner, peut entraîner un sommeil fragmenté et perturber les activités quotidiennes.
Les médecins de famille et les spécialistes doivent absolument diagnostiquer la nycturie, car elle peut engendrer une mauvaise santé, et notamment des troubles comme une augmentation des risques de chutes et d'accidents, une maladie cardiovasculaire, un diabète, une dépression et un plus grand taux de morbidité et de mortalité.
Une anamnèse exhaustive va faciliter le diagnostic de nycturie.
Des modifications du mode de vie, notamment une urinationdes mictions selon un horaire préétabli, des restrictions alimentaires et des apports liquidiens, un horaire de prise de médicaments, une hygiène du sommeil, et l'élévation des jambes en soirée peuvent soulager certains patients atteints de nycturie.
Le traitement de deuxième intention consiste à prendre de la desmopressine, un antidiurétique qui peut réduire le nombre de mictions nocturnes et améliorer ainsi le sommeil, notamment pour les femmes.
Veuillez vous abonner pour accéder à l’article complet pour lequel ces outils ont été conçus. L’abonnement ne coûte que 20 $ US par an et vous permettra d’accéder à tout le contenu de qualité de www.healthplexus.net ― un portail éducatif qui héberge 1 000 évaluations cliniques, études de cas, supports visuels éducatifs et bien plus encore ―, et de l’application mobile.
Disclaimer: 
Cet article a été rédigé pour faire partie de la ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE. La ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE a pu être élaborée grâce à une subvention pédagogique de Ferring Inc.

Soins complets aux patients dans le cadre de la prise en charge de la nycturie

Soins complets aux patients dans le cadre de la prise en charge de la nycturie

Teaser: 

Dr Dean S. Elterman, M.D., M.Sc., FRCSC, chirurgien urologue titulaire, Toronto Western Hospital, University Health Network; professeur adjoint, division d’urologie, département de chirurgie, université de Toronto, Toronto (Ont.).

Ce supplément offre une vue d’ensemble de la nycturie, de ses répercussions sur les patients et des diverses options thérapeutiques offertes au médecin généraliste. La nycturie est un trouble courant qui conduit le patient à se réveiller pour uriner. Elle touche habituellement les patients âgés, bien qu’elle puisse également s’observer chez des personnes plus jeunes. Étant donné que ce trouble est associé au vieillissement et que de nombreux cas de nycturie ne sont souvent pas signalés, il est important que les médecins en fassent le dépistage.

Par nature, la nycturie est polysystémique et les causes de ce trouble sont multiples : on trouve notamment une insuffisance cardiaque congestive, un mauvais fonctionnement rénal, un diabète et une polyurie nocturne (production excessive d’urine la nuit). La nycturie est un symptôme du bas appareil urinaire qui est parfois associé à divers troubles urologiques courants, comme une vessie hyperactive et une hyperplasie bénigne de la prostate.

La nycturie revêt une importance particulière en raison de ses répercussions sur la qualité de vie du patient. Des réveils nocturnes fréquents pour uriner peuvent laisser les patients dans un état chronique de manque de sommeil et de fatigue, et entraîner des atteintes fonctionnelles dans la journée et au travail. La nycturie peut provoquer des chutes et des fractures pour les personnes susceptibles, notamment la nuit en raison du manque de visibilité. Les patients qui n’arrivent pas à se rendre suffisamment rapidement aux toilettes la nuit pourraient avoir des épisodes d’incontinence. La nycturie pourrait être la seule plainte du patient, tout en étant le symptôme possible de nombreuses maladies; le médecin doit alors prescrire des examens supplémentaires pour arriver à poser un diagnostic et décider du traitement. La nycturie est parfois associée à d’autres troubles des voies urinaires, comme une infection et une inflammation. Le diagnostic est d’autant plus important qu’il existe des traitements pour la maladie sous-jacente ou pour la polyurie nocturne, une cause courante de nycturie.

Cette publication se concentre sur la polyurie nocturne en tant que cause fréquente et traitable de la nycturie. Le diagnostic de polyurie nocturne se pose à l’aide des antécédents médicaux, de l’examen physique et des calendriers mictionnels. Le traitement dépend du degré de symptomatologie du patient et commence simplement avec une réduction de la consommation liquidienne (alcool et caféine) avant le coucher, des mictions selon un horaire préétabli et une hygiène du sommeil. De nombreux patients ne connaissent pas les répercussions de leurs routines sur la nycturie et de simples changements peuvent s’avérer très efficaces.

Le traitement médical correspond à la prise de comprimés de desmopressine à désintégration orale avant le coucher. La desmopressine, un analogue de l’hormone antidiurétique, permet de réduire la production nocturne d’urine et présente une courte durée d’action. Les nouvelles préparations de desmopressine entraînent beaucoup moins de cas d’hyponatrémie. Cependant, il faut toujours mesurer la concentration sérique en sodium des patients avant le début du traitement.

Disclaimer: 
Cet article a été rédigé pour faire partie de la ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE. La ressource de FMC en ligne sur les DERNIÈRES NOUVEAUTÉS EN MATIÈRE DE DIAGNOSTIC ET DE TRAITEMENT DE LA NYCTURIE a pu être élaborée grâce à une subvention pédagogique de Ferring Inc.

Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Teaser: 

Dean Elterman, MD, FRCSC, Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON.

This supplement provides an overview of nocturia, its impact on patients and various treatment options available to the general practitioner. Nocturia is a common condition, whereby patients are awakened from sleep with the need to urinate. Typically associated with older patients, it can also occur in younger populations. It is often underreported and attributed to aging by patients, indicating the importance of screening by physicians.

Its causes are numerous and multisystem in nature, including congestive heart disease, kidney dysfunction, diabetes and nocturnal polyuria – an over production of urine at night. Nocturia is a lower urinary tract symptom, and may be seen with several common urologic conditions such as overactive bladder and benign prostatic hyperplasia.

Nocturia is particularly important because of its impact on quality of life. Frequently waking to pass urine can leave patients chronically fatigued and sleep deprived, leading to impairment during the day and at work. For those at risk of falls and fractures it can be a cause, especially with poor visibility at night. Patients who are unable to make it to the washroom urgently may experience episodes of incontinence during the night. As a possible symptom of many different diseases, nocturia may be the presenting complaint that prompts further investigations and eventually leads to a diagnosis and treatment. It may be associated with other urinary tract conditions including infection and inflammation. Its diagnosis is equally important because of available treatments for either the underlying disease or for nocturnal polyuria—a common cause of nocturia.

This publication focuses on nocturnal polyuria as a common and treatable cause of nocturia. Diagnosis of nocturnal polyuria is made via history, physical exam and frequency-voiding charts. Treatment is tailored to the degree that the patient is symptomatic and begins conservatively with reduction in fluid intake (alcohol and caffeine) before bed, timed voiding and sleep hygiene. Many patients are unaware of the impact that their habits have on nocturia, and simple changes may be very effective.

Medical management involves desmopressin taken as an oral disintegrating tablet before bed which acts as an antidiuretic hormone to reduce urine production overnight in a short acting manner. Newer formulations have significantly lower rates of hyponatremia which must be measured before initiating therapy.

Disclaimer: 
This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource. The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Teaser: 

1Dean Elterman, MD, FRCSC, 2Co-authors: Brandon Van Asseldonk B. Eng

1Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON

2Faculty of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Nocturia is a common urologic condition with prevalence increasing in the elderly and can result in fragmented sleep, impaired daytime functioning, and falls. It can be a symptom of BPH or OAB but is commonly multifactorial with fluid intake, sleep apnea, and diabetes contributing. Nocturia is often a result of nocturnal polyuria which is best diagnosed by recording voiding frequency and volumes. Treatment is driven by patient symptoms and reported level of bother, with first-line therapy being lifestyle modification and second-line therapy being desmopressin (Nocdurna).
Key Words: Nocturia, Nocturnal Polyuria, Nocdurna, Desmopressin.

Nocturia is a common urologic condition, particularly in elderly populations.
Nocturia, or waking twice or more during the night to void, can cause fragmented sleep and can impair function during the day.
It is essential that primary care physicians and specialists diagnose nocturia because it can lead to poor health, including conditions like: an increased risk of falls and accidents, cardiovascular disease, diabetes, depression, and increased morbidity and mortality.
A thorough history will aid in the diagnosis of nocturia.
Lifestyle modifications, including: timed voiding, dietary and fluid restrictions, medication timing, sleep hygiene, and evening leg elevation can provide some relief for nocturia patients.
Second-line treatment is the use of desmopressin, an antidiuretic that can reduce the number of nighttime voids and thus improve sleep, particularly in women.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is only $20 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Disclaimer: 

This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource.
The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.