Ways of solving diagnostic problems caused by nocturia in patients with benign prostatic hyperplasia

Relevance. Today LUTS cause a lot of complexity and misunderstanding among doctors and patients. Among the symptoms, nocturia is the most difficult to interpret. Nocturia affects a significant part of the population, especially in older age groups. Currently, there are no data on the ratio of nocturia in various diseases of neurological etiology which are manifested by nocturia. Nocturia can be classified only according to urination diaries: diurnal polyuria, nocturnal polyuria, decreased bladder capacity, sleep disorders, and circadian rhythm disorders. Nocturia is also classified by degree of severity: mild severity from 1 to 3 episodes of nocturnal urination and severe when the number of nocturnal awakenings for urination is more than 3.

Objective. To prove the effectiveness of the analysis of additional data on the daily diary of urination, together with the determination of the specific gravity of urine in the daytime and at night in patients with nocturia.

Material and Methods. Two hundred eleven male patients were examined, with nocturia from 1 to 6 times and with a diagnosis of benign prostatic hyperplasia (BPH). The average age of the patients was 71 ± 4.7 years, the age interval of patients ranged from 50 to 84 years. the presence of symptoms of the lower urinary tract (LUTS), the total score on the I-PSS scale >21, an indicator of the quality of life index QOL >3, the maximum flow rate of urine (Q_max) >10 ml/s, residual urine volume (OOM) <150 ml.

Discussion. The lack of improvement in urination disorders and the inability to determine the type of nocturia led to an in-depth analysis of urination diaries taking into account the duration of night sleep, determination of night and day diuresis, and also, features of deviation of the urine specific gravity at night. Together with one of the days of urination diary filling, it was recommended to perform a urinalysis according to Zimnitsky. In 4 (1.8%) patients, daily polyuria with diuresis of more than 40 ml/kg per day was determined. One hundred thirty-nine (65.8%) people had nocturnal polyuria with a predominance of nocturnal diuresis of 1.8 ± 0.8 ml/min over daytime 1.32 ± 0.3 ml/min. A decrease in bladder capacity was detected in 56 (26.5%) male patients. Twelve (5.6%) patients had various sleep disorders, which was the reason for their awakening.

Findings. An in-depth analysis of urination diary data, including information on the duration of sleep and the determination of the circadian rhythm of the specific gravity of urine, is the key to successfully determining the cause of nocturia, especially in patients with nocturnal polyuria. 

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