Elsevier

Urology

Volume 60, Issue 5, Supplement 1, November 2002, Pages 28-32
Urology

Nocturnal polyuria versus overactive bladder in nocturia

https://doi.org/10.1016/S0090-4295(02)01789-2Get rights and content

Abstract

The purpose of this article is to review the current state of knowledge on contributions of nocturnal urine overproduction and overactive bladder to the syndrome of nocturia. We review the recent literature and current state of the art in differential diagnosis, pathophysiology, and classification of nocturia. We found that multiple pathologic factors may result in nocturia, including cardiovascular disease, diabetes mellitus or insipidus, third spacing of fluid, sleep apnea, lower urinary tract obstruction, primary sleep disorders, and behavioral and environmental factors. Thus, nocturia may be attributed to nocturnal polyuria (nocturnal urine overproduction), diminished nocturnal bladder capacity, or both. Distinction between these conditions is made by a simple arithmetic analysis of the 24-hour voiding diary. Understanding the manifold origins of nocturia will lead to rational treatment of specific contributing pathophysiologic factors.

Section snippets

Nocturnal polyuria

The increased production of urine at night experienced in NP is offset by lowered daytime urine production, such that the 24-hour urine volume remains normal.6 A reason for this diurnal change is thought to be a disruption of the diurnal variation in secretion of arginine vasopressin (AVP). AVP, normally secreted in a diurnal pattern, is partly responsible for regulation of urine production.18 Because AVP increases the resorption of water from the renal tubule, higher concentrations of AVP

Nocturia caused by diminished nocturnal bladder capacity

Nocturia caused by diminished NBC is of 2 general types: decreased FBC and decreased NBC. In both conditions, NUV exceeds bladder capacity and the patient is awakened by the need to void because the bladder does not hold enough. The FBC is the largest volume voided as recorded in the micturition diary. If the FBC is less than NUV, nocturia ensues.35

To quantify NBC, several terms need to be defined: nocturia index (Ni) and the NBC index (NBCi). The Ni is NUV divided by FBC; the first morning

Mixed causes for nocturia

Many patients with nocturia are found to have a combination of NP and low NBC. We term this a mixed origin of nocturia. A recent study37 of nocturia in elderly patients determined that older patients with nocturia tend to have higher NUVs and lower FBCs than their counterparts without nocturia. However, the ratio between NUV and FBC (otherwise known as the Ni38) allowed a more significant discrimination of the origin of nocturia in elderly patients than either variable alone: In patients with

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    Jeffrey P. Weiss is a study investigator funded by, and a paid consultant to, Ferring Pharmaceuticals, Copenhagen, Denmark.

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