Professor of Urology University of California Los Angeles Los Angeles, California, United States
Objectives: Nocturia is a multifactorial condition that affects up to 25% of the population. A bladder diary (BD) is standard method of evaluation of bladder conditions, comprised of the flow volume chart in addition to details regarding incontinence severity. Current BDs are limited regarding nocturia documentation, leaving up to 50% of patients without clear bladder diagnosis. Elaborating on circumstances surrounding nocturia events may help better characterize nocturia patterns and etiology.
Methods: This is a retrospective study of patients to whom bladder diary was recommended at a single academic urogynecology clinic. The standard 3-day diary was expanded, allowing patients to document nocturia details. Feasibility was calculated according to completion of thirteen variables: twelve standard diary variables (i.e. day time frequency, night time frequency, urgency, etc.) and one variable documenting “night time reason for awakening”. Urgency and reported reasons for awakening (“bladder pain”, “bladder urge”, “bladder leakage,” “non-bladder reason”, or ad lib) were reviewed.
Results: 59 women over 6 months received an expanded BD. 66% were returned and 32 diaries were available for analysis. BDs were recommended to women with bothersome nocturia (58%), isolated nocturia (6.4%), lower urinary tract symptoms (61.3%), urge incontinence (16.1%), and mixed incontinence (19.3%). Patients were 63+15.4 years old with depression/anxiety (16.1%), hypertension (9.7%) and diabetes (12.9%). 23% patients self-reported a sleep disorder, but only one demonstrated no nocturia.
Total composite feasibility was 77.38% for all patients and 82.68% for patients with 1+ episodes of nocturia. 58% of all patients and 68% of nocturia patients responded to >80% of the evaluated variables. There was no difference in number of diaries completed >80% when the additional nocturia variable was excluded (p=0.16). 158 nocturia events were captured with average 2.0+1.54 voids/night (52.2% with 0-2 voids/night and 48% with 2+ voids/night). Patients with reported sleep disorder, bothersome nocturia, or nocturnal urinary symptoms averaged 2.6+1.34 voids/night. A bladder-specific nocturia etiology was identified in 61.5% of patients (26.9% reduced night capacity, 19.2% global reduced capacity, 15.4% nocturnal polyuria).
74.7% nocturia events documented reason for awakening. Urinary urge (51.7%) was the most common reason. Patients reported average nocturia urgency (range 0-3) of 1.75+0.83 with 0- < 2 voids, 1.73+0.66 with 2- < 3 voids, and 2.11 with 3+ voids/night (p=0.5). Other reasons for awakening were bladder or genitourinary pain (18.6%), poor or no sleep (9.3%), and unknown (5.9%). Non-bladder reasons for awakening (8.5%) included partner-related, physical discomfort, or sleep environment factors leading to nocturnal void.
Conclusions: Bladder diary expansion to allow patient-reported details surrounding nocturia may be a feasible method to better characterize nocturia events. Augmenting documentation of nocturnal voiding events may help better characterize nocturia and identify etiologies involving and beyond the bladder. Further validation and reliability testing for various bladder conditions is warranted.
