Aktuelle Urol 2013; 44(6): 465-476
DOI: 10.1055/s-0033-1351026
Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Nykturie – ein oft verkanntes Problem

Nocturia – An Often Misjudged Problem
M. J. Mathers
1   PandaMED Remscheid, Urologische Kooperationspraxis der Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Remscheid
,
S. Roth
2   Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
,
F. C. von Rundstedt
2   Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
,
S. Degener
2   Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
› Author Affiliations
Further Information

Publication History

Publication Date:
26 November 2013 (online)

Zusammenfassung

Die Nykturie – darunter versteht man das Gewecktwerden durch Harndrang mit anschließender Blasenentleerung – stellt für die Betroffenen ein ernstes Problem dar. In den letzten Jahrzehnten ist die Nykturie hauptsächlich als irritatives Symptom der benignen Prostatahyperplasie (BPH) betrachtet worden. Häufig jedoch wird das Symptom wenig durch die verschiedenen Behandlungen der BPH beeinflusst. Erst seit einigen Jahren hat man erkannt, dass die Prostata weniger an der Symptomatik beteiligt ist, als man vorher geglaubt hatte, denn von der Nykturie sind ebenso viele Frauen betroffen. Aus diesem Grund wird die Nykturie heutzutage anders betrachtet. Es ist ein hoch prävalentes Symptom, das sich bei Männern und Frauen weder quantitativ noch qualitativ unterscheidet. Viele Faktoren führen zu einer Nykturie. Unter anderem sind folgende Erkrankungen daran beteiligt: koronare Herzkrankheit, Diabetes mellitus oder insipidus, Lower Urinary Tract Symptoms (LUTS), Angstzustände oder primäre Schlafstörungen sowie Verhaltens- und Umweltfaktoren. Im Wesentlichen handelt es sich bei der Nykturie entweder um eine nächtliche Polyurie (nächtliche Urinüberproduktion) oder eine verringerte nächtliche Blasenkapazität bzw. eine Kombination aus beidem. Eine Unterscheidung dieser Entitäten kann durch einfache arithmetische Analyse z. B. eines 48-stündigen Miktionstagebuchs bestimmt werden. Erst seit Kurzem ist die Nykturie gemäß der Ätiologie und Pathogenese klassifiziert worden, sodass jetzt eine differenzierte Behandlung möglich ist. In Fällen, in denen die zugrunde liegende Ursache nicht gefunden werden kann, können zwar Verhaltensmaßnahmen helfen, oft sind jedoch medikamentöse Therapien notwendig. Die medikamentöse Behandlung umfasst: Desmopressin, antimuskarinerge Substanzen, allgemeinmedizinische Maßnahmen wie Stützstrümpfe der Beine, zeitliche Veränderung der Diuretikaeinnahme oder in speziellen Fällen die nasale CPAP-Beatmung (Continuous Positive Airway Pressure). Trotz der z. T. hohen Effektivität der Maßnahmen sollte aufgrund der möglichen Nebenwirkungen individuell ein Therapiekonzept erarbeitet werden.

Abstract

Nocturia – waking up during the night due to the urge to urinate and empty the bladder – is a serious problem for affected patients. In the past decades, nocturia has been primarily regarded as an irritative symptom of benign prostate hyperplasia (BPH). This symptom is however frequently not influenced by different BPH treatments. In the last couple of years one has come to the conclusion that the prostate is less involved and in part responsible for the symptoms since women are also frequently affected. For these reasons nocturia is looked at differently. It is a highly prevalent symptom which neither qualitatively nor quantitative differs between men and women. Many factors lead to nocturia. The following diseases are involved: coronary heart disease, diabetes mellitus or insipidus, lower urinary tract symptoms (LUTS), states of anxiety or insomnia as well as behavioural and environmental factors. Nocturia can be categorised in nocturnal polyuria (overproduction of nightly urine) or a diminished bladder capacity or a combination of both. These entities can be easily differentiated by arithmetic analysis, e.g., a 48-hour voiding diary. Only recently nocturia has been classified according to the aetiology and pathogenesis, making a differentiated treatment possible. However, even in the cases in which the underlying cause cannot be found behavioural changes can help. Nevertheless, pharmacological treatments are inevitable. Medical treatments include: desmopressin, anticholinergics and antimuscarinics, general-medical measures like support stockings, different time for the intake of diuretics or in specific cases the nasal CPAP artificial respiration (continuous positive airway pressure). In spite of the partly high effectiveness of these measures, treatment should be customised taking possible side effects in account.

 
  • Literatur

  • 1 Speakman M. Efficacy and safety of Tamsulosin OCAS. BJU Int 2006; 98 (Suppl. 02) 13-17
  • 2 Djavan B, Milani S, Davies J et al. The impact of Tamsulosin oral controlled absorption system (OCAS) on nocturia and the quality of sleep: preliminary results of a pilot study. Eur Urol Suppl 2005; 4: 61-68
  • 3 Johnson 2nd TM, Jones K, Williford WO et al. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. J Urol 2003; 170: 145-148
  • 4 Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50: 1306-1314
  • 5 Matthiesen TB, Rittig S, Norgaard JP et al. Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms. J Urol 1996; 156: 1292-1299
  • 6 Hetta J, Rimon R, Almqvist M. Mood alterations and sleep. Ann Clin Res 1985; 17: 252-256
  • 7 Galizia G, Lengellotto A, Cacciatore F et al. Association between nocturia and falls-related long-term mortality risk in the elderly. J Am Med Dir Assoc 2012; 13: 640-644
  • 8 Nakagawa H, Niu K, Hozawa A et al. Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol 2010; 184: 1413-1418
  • 9 Asplund R, Johansson S, Henriksson S et al. Nocturia, depression and antidepressant medication. BJU Int 2005; 95: 820-823
  • 10 Asplund R, Aberg H. Diurnal variation in the levels of antidiuretic hormone in elderly subjects with nocturia. J Intern Med 1991; 229: 131-134
  • 11 Van Kerrebroeck P, Abrams P, Chaikin D et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 179-183
  • 12 Asplund R, Sundberg B, Bengtsson P. Desmopressin for treatment of nocturnal polyuria in the elderly: a dose-titration study. Br J Urol 1998; 82: 642-646
  • 13 Rittig S et al. Adult nocturnal enuresis: a circadian defect in free water excretion. Clin Res 1993; 41: 666A
  • 14 Saito M, Kondo A, Kato T et al. Frequency-volume charts comparison of frequency between elderly and adult patients. Br J Urol 1993; 72: 35-41
  • 15 Coyne KS, Zhou Z, Bhattacharyya SK et al. The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA. BJU Int 2003; 92: 948-954
  • 16 Van Dijk L, Kooji DG, Schellevis FG. Nocturia in the Dutch adult population. BJU Int 2002; 90: 644-648
  • 17 Tikkinen KA, Tammela TL, Huhtala H et al. Is nocturia equally common among men and women? A population based study in Finland. J Urol 2006; 175: 596-600
  • 18 Yoshimura K, Terada N, Matsui Y et al. Pravalence of and risk factors for nocturia: analysis of a health screening program. Int J Urol 2007; 11: 282-287
  • 19 Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol 2010; 184: 440-446
  • 20 Yoshimura K, Kamoto T, Tsukamoto R et al. Seasonal alterations in nocturia and other storage symptoms in three japanese communities. Urol 2007; 69: 864-870
  • 21 Pressman MR, Figueroa WG, Kendrick-Mohamed J et al. Nocturia. A rarely recognised symptom of sleep apnea and other occult sleeping disorders. Arch Intern Med 1996; 156: 545-550
  • 22 Weiss JP, Blavais JG. Nocturia. J Urol 2000; 163: 5-12
  • 23 Reddi AS. Essentials of renal Physiology. East Hanover, NJ: College Book Publishers; 1999: 171
  • 24 Graugaard-Jensen C, Rittig S, Djurhuus JC. Nocturia and circadian blood pressure profile in healthy elderly male volunteers. J Urol 2006; 176: 1034-1039 discussion 1039
  • 25 Fitzgerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol 2006; 194: 1399-1403
  • 26 Endeshaw YW, Johnson TM, Kutner MH et al. Sleep-disordered breathing and nocturia in older adults. J Am Geriatr Soc 2004; 52: 957-960
  • 27 Yalkut D, Lee LY, Grider J et al. Mechanism of atrial natriuretic peptide release with increased inspiratory resistance. J Lab Clin Med 1996; 128: 322-328
  • 28 Mathers MJ, Lazica DA, Roth S. [Non-bacterial cystitis: principles, diagnostics and etiogenic therapy options]. Aktuel Urol 2010; 41: 1-8
  • 29 Weiss JP, Blaivas JG, Jones M et al. Age related pathogenesis of nocturia in patients with overactive bladder. J Urol 2007; 178: 548-551
  • 30 Primus G, Madersbacher H, Elnekheli M et al. Differentialdiagnose und Therapie der Nykturie – Konsensusstatement. J Urol Urogynäkol 2006; 13: 21-27
  • 31 Boongird S, Shah N, Nolin TD et al. Nocturia and aging: diagnosis and treatment. Adv Chronic Kidney Dis 2010; 17: e27-e40
  • 32 Van Kerrebroeck P, Razapur M, Cortesse A et al. Desmopressin in the treatment of nocturia. Eur Urol 2007; 52: 221-229
  • 33 Ljung R. Use of desmopressin and concomitant use of potentially interacting drugs in elderly patients in Sweden. Eur J Clin Pharmacol 2008; 64: 439-444
  • 34 Torimoto K, Hirayama A, Samma S et al. The relationship between nocturnal polyuria and the distribution of body fluid: assessment by bioelectric impedance analysis. J Urol 2009; 181: 219-224
  • 35 Sugaya K, Nishijima S, Miyazato M et al. Investigation of biochemical factors related to non-bothersome nocturnal urination. Biomed Res 2007; 28: 213-217
  • 36 Tajima F, Sagawa S, Iwamoto J et al. Renal and endocrine responses in the elderly during head-out water immersion. Am J Physiol 1988; 254 (6 Pt 2) R977-R983
  • 37 Johnson 2nd TM, Burgio KL, Redden DT et al. Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc 2005; 53: 846-850
  • 38 Andersson KE, Yoshida M. Antimuscarinics and the overactive detrusor – which is the main mechanism of action?. Eur Urol 2003; 43: 1-5
  • 39 Yokoyama O, Yamaguchi O, Kazizaki H et al. Efficacy of solifenacin on nocturia in Japanese patients with overactive bladder: impact on sleep evaluated by bladder diary. J Urol 2011; 186: 170-174
  • 40 Hedge SS. Muscarinic receptors in the bladder: from basic research to therapeutics. Br J Pharmacol 2008; 147: S80-S87
  • 41 Rudy D, Cline K, Harris R et al. Multicenter phase III trail studying trospium chloride in patients with overactive bladder. Urology 2006; 67: 275-280
  • 42 Haab F, Stewart L, Dwyer P. Darifenacin, an M3 selective receptor antagonist, is an effective and well-tolerated once-daily treatment for overactive bladder. Eur Urol 2004; 45: 420-429
  • 43 Dmochowski R, Abrams P, Marschall-Kehrel D et al. Efficacy and tolerability of tolterodine extended release in male and female patients with overactive bladder. Eur Urol 2007; 51: 1054-1064
  • 44 Pak RW, Petrou SP, Staskin DR. Trospium chloride: a quaternary amine with unique pharmacological properties. Curr Urol Rep 2003; 4: 436-440
  • 45 Katz IR, Sands LP, Bilker W et al. Identification of medications that cause cognative impairment in older people: the case of oxybutynin chloride. J Am Geriatr Soc 1998; 46: 8-13
  • 46 Tsao JW, Heilman KM. Transient memory impairment and hallucinations associations with tolterodine. N Engl J Med 2003; 349: 2274-2275
  • 47 Williams SG, Staudenmeier J. Hallucinations with tolterodine. Psychiatr Serv 2004; 55: 1318-1319
  • 48 Lipton RB, Kolodner K, Wesnes K. Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol 2005; 173: 493-498
  • 49 Doroshyenko O, Jetter A, Odenthal KP et al. Clinical pharmacokinetics of trospium chloride. Clin Pharmacokinet 2005; 44: 701-720
  • 50 Geyer J, Gavrilova O, Petzinger E. The role of p-glycoprotein in limiting brain penetration of the peripherally acting anticholinergic overactive bladder drug trospium chloride. Drug Metabol Dispos 2009; 37: 1371-1374
  • 51 Geyer J, Gavrilova O, Schwantes U. Differences in the brain penetration of the anticholinergic drugs trospium chloride and oxybutynin. UroToday Int J 2010; DOI: 10.3834/uij.1944-5784.2010.02.12.
  • 52 Gulur DM, Drake MJ. Management of overactive bladder. Nat Rev Urol 2010; 7: 572-582