Expert panel of 4 urologists and 1 urogynecologist has created a framework for assigning nocturia to the subgroups. They reviewed 2 possible approaches to the classification: concentrating on such individual characteristics as patient’s age, gender, and disease or focusing on clinical features like 24-hour voided volume, uroflow, bladder capacity, and post void residual (PVR). Second pathway was chosen for the study because treatment choices are based on clinical tests (Figure 1).
Retrospective data were collected of subjects who completed 24-hour bladder diary, lower urinary tract symptoms questionnaire, and uroflow and PVR measurements. Patients who reported one or more nocturic episodes were included into analysis.
295 out of 331 subjects were considered eligible for the research. Nocturia was reported in 228 patients. Following measures were included to the classification: 24-hour voided volume, maximum voided volume, nighttime voids, nocturnal polyuria index, uroflow and PVR. Figure 2 reflects phenotypes that were selected based on the measurements.
First, study participants were grouped into 5 major phenotypes: polyuria, nocturnal polyuria, small bladder capacity, mismatches, and sleep disturbances. Then, each primary group was divided into 30 subgroups according to the PVR, maximum voided volume, and uroflow. When the panel excluded some phenotypes, overall number of groups reduced to 22.
According to the presenter, certain phenotypes can occur simultaneously like polyuria and nocturnal polyuria, thus one treatment option can potentially address both concerns. However, proposed guidelines can aid clinicians and other healthcare providers in individualized diagnoses and consecutive treatment plans. Future studies are necessary to possible develop innovative therapies based on the specific phenotypes.
It is important to consider multiple risk factors when treating nocturia including patient’s lifestyle, sleep patterns, cardiovascular and neurological conditions, and other urological characteristics related to bladder and prostate health. Nocturia phenotypes can aid to create a tailored approach to the patient health.
Presented by Linda Dayan, Institute for Bladder and Prostate Research, New York, NY
Coauthors: Blaivas J, Kreder K, Chaikin D, O'Boyle A L, Poon M
Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania, Twitter: @PennUrology at the 2018 ICS International Continence Society Meeting - August 28 - 31, 2018 – Philadelphia, PA USA