Determinants of nocturia: the Krimpen study

Abstract

Purpose: Many conditions and characteristics are cross-sectionally associated with nocturia. However, to our knowledge longitudinal associations of frequency-volume chart based nocturia have not yet been studied. We identify (modifiable) determinants of nocturia in older men in a longitudinal setting.

Materials and methods: A longitudinal, community based study was conducted among 1,688 men age 50 to 78 years in Krimpen aan den IJssel, The Netherlands with planned followup rounds at 2, 4 and 6 years. Men without a history of radical prostatectomy, transurethral surgery, or bladder or prostate cancer were included in the study. Data were obtained using frequency-volume charts, from which the nocturnal voiding frequency, maximum voided volume and (nocturnal) urine production were determined. Nocturia was defined as a nocturnal voiding frequency of 2 or more episodes. Polyuria was defined as greater than 2,800 ml voided per 24 hours. For nocturnal polyuria we used the 2 definitions of 1) greater than 33% of 24-hour voided volume and 2) nocturnal urine production of greater than 90 ml per hour. Conditions and characteristics were determined via medical examinations and questionnaires. A generalized linear mixed effect model was used to determine factors longitudinally associated with nocturia.

Results: Age (50 to 55 years vs greater than 60 years), maximum voided volume (greater than 300 ml vs less than 300 ml), 24-hour polyuria, nocturnal polyuria (both definitions) and lower urinary tract symptoms were all longitudinally associated with an increased prevalence of nocturia in older men.

Conclusions: A smaller maximum voided volume, lower urinary tract symptoms, 24-hour polyuria and nocturnal polyuria are significant and potentially modifiable determinants of nocturia. The finding that both definitions for nocturnal polyuria are independent significant determinants may indicate a 2-step etiologic process for nocturnal polyuria.

Keywords: epidemiology; lower urinary tract symptoms; nocturia; polyuria; prostatic hyperplasia.