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Benign Prostatic Hyperplasia With Nocturia

Impact Of Luts/bpe Severity On Insomnia And Other Sleep Disorders

Updates in LUTS: Treating Overactive Bladder and Nocturia

Among the 2179 patients with poor sleep who completed the HD-43 sleep questionnaire, 60.9% responded to the definition of insomnia according to the international classifications. Beside these insomniacs, an additional 7.9% responded to the subjective criteria for RLS and 6.4% to the minimum subjective criteria in favour of sleep apnoea . Sleepiness was high in 32.3% of the patients and major in 3.1% of them ESS .

  • The number of reported nocturia episodes was significantly associated with the presence of insomnia: 95% of patients with five or more episodes of nocturia had insomnia versus 36.9% of those with two episodes . Conversely, insomniacs reported more nocturia episodes ) than non-insomniacs , p< 0.001). Patients with LUTS/BPE complained more often of nocturnal awakenings than difficulty initiating sleep . Overall, 78.6% of subjects reported normal sleep latency < 30min, 16.2% between 30 and 60min and only 5.2% above 60min.

  • Reporting a 24h diuresis did not affect the frequency of insomnia .

  • The I-PSS was higher in insomniacs than in subjects with no insomnia vs 15.6 , p< 0.001), and insomnia was more prevalent in subjects with a severe I-PSS than in those with moderate or mild scores .

The number of nocturia episodes was significantly associated with more reported sleepiness and excessive sleepiness . The 24h diuresis volume also moderately affected sleepiness, but there was no association found between the I-PSS and ESS.

Fedovapagon For Nocturia In Men With Benign Prostatic Hyperplasia

Fedovapagon is in clinical development as an oral treatment for nocturia in men with benign prostate enlargement. Nocturia is a common symptom in men who have enlarged prostates. Nocturia is generally defined as excessive or disruptive night-time urination which disrupts sleep and impairs quality of life. There are currently no specific treatments for nocturia in men with enlarged prostates. Instead, nocturia is currently managed with drugs prescribed to treat the general symptoms of enlarged prostates, which are rarely effective in treating nocturia and can have side effects. As this is a common symptom in men with this condition, there is a clinical need for this type of treatment.Fedovapagon works directly in the collecting ducts of the kidney by binding to, and activating receptors that causes the kidneys to reabsorb water from urine as it passes towards the bladder. If fedovapagon is administered before going to bed the result is less urine produced overnight. Therefore, if licensed, fedovapagon would be the first medicinal product specifically for the treatment of nocturia in men with enlarged prostates.

Questions To Ask Your Doctor

  • Do I need to see a specialist?
  • If I need a specialist, can you give me a referral?
  • Will I need to have tests to find the cause of my nocturia?
  • What other problem could be causing my symptoms, and why?
  • What treatments do you think are right for me and why?
  • What are the pros and cons of each type of treatment?
  • After I start treatment, are there problems I should I watch for?
  • How soon after treatment will I feel better?
  • When should I call you?
  • Will I need treatment for the rest of my life?

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Bladder Storage Problems Or Decreased Nocturnal Bladder Capacity

Patients with nocturia who do not have either polyuria or nocturnal polyuria according to the above criteria, will most likely have a reduced voided volume or a sleep disorder. NBC is defined as the largest voided volume during the hours of sleep. Decreased NBC can be related to decreased maximum voided volume or decreased NBC. Decreased NBC can be related to prostatic obstruction, nocturnal detrusor overactivity, neurogenic bladder, primary bladder pathology such as cancer , learned voiding dysfunction, anxiety disorders, certain pharmacological agents, or bladder and ureteral calculi. Some mathematical indices have been suggested to describe this situation.

NBC index is a more complicated formula that addresses voids at night in patients with decreased NBC. NBCi is actual number of nightly voids minus predicted number of nightly voids . PNV is derived by calculating nocturia index and subtracting 1. NBCi greater than 0 indicates nocturia occurring at volumes less than MVV.

Benign Prostatic Hyperplasia With Lower Urinary Tract Symptoms

Benign Prostatic Hyperplasia (BPH)
    20162017 – Revised Code20182019202020212022Billable/Specific CodeAdult Dx Male Dx
  • N40.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • Short description: Benign prostatic hyperplasia with lower urinary tract symp
  • The 2022 edition of ICD-10-CM N40.1 became effective on October 1, 2021.
  • This is the American ICD-10-CM version of N40.1 – other international versions of ICD-10 N40.1 may differ.
  • N40.1 is applicable to adult patients aged 15 – 124 years inclusive.
  • N40.1 is applicable to male patients.

“use additional code”

  • code for associated symptoms, when specified:
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    Appendix A: Search Strategy

  • exp *Lower Urinary Tract Symptoms/
  • lower urinary tract.ti,ab.
  • exp *Urinary Bladder Neck Obstruction/
  • bladder outlet obstruction.ti,ab.
  • .ti,ab.
  • 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13
  • silodosin.mp.
  • 15 or 16 or 17
  • oxybutynin.ti,ab.
  • levitra.ti,ab.
  • 49 or 50 or 51
  • 18 or 21 or 24 or 27 or 30 or 33 or 36 or 39 or 42 or 45 or 48 or 52
  • 14 and 53
  • ).tw.
  • exp Review Literature as Topic/
  • or/55-60
  • 81 not
  • or/78-80,83
  • 61 or 66 or 72 or 77
  • 85 not 84
  • randomized controlled trials as topic/
  • randomized controlled trial/
  • exp Clinical trials as topic/
  • or/87-101
  • adj ).tw.
  • placebos/
  • 103 or 104 or 105 or 106 or 107 or 108
  • 102 or 109
  • 111 or 112 or 113 or 114
  • 110 not 115
  • .fs.
  • .ti,ab.
  • side effec*.ti,ab.
  • adj3 ).mp.
  • exp Product Surveillance, Postmarketing/
  • exp “Drug-Related Side Effects and Adverse Reactions”/
  • exp Adverse Drug Reaction Reporting Systems/
  • exp Clinical Trials, Phase IV as Topic/
  • exp Poisoning/
  • .ti,ab.
  • 118 or 119 or 120 or 121 or 122 or 123 or 124 or 125 or 126 or 127
  • 117 and
  • limit 129 to
  • 129 not 130
  • limit 131 to “all child “
  • limit 132 to “all adult “
  • 131 not 132
  • 134 or 133
  • 135 and
  • 135 and 86
  • Review Of Key Questions

    AHRQ posted the key questions on the Effective Health Care Web site for public comment. The EPC refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel . This input is intended to ensure that the key questions are specific and relevant.

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    Demographic And Baseline Clinical Data

    Data from a total of 5775 men being documented by 822 urology offices were collected. Patients had an average age of 66 ± 9 years, height of 176 ± 6 cm, weight of 83 ± 10 kg, and a body mass index of 26.7 ± 2.8 kg/m2. Many participants were newly diagnosed , whereas others had previously been followed by watchful waiting or been treated with an herbal remedy , an -blocker or a 5-reductase inhibitor . The comorbidities of heart failure, diabetes or sleep apnea were noted in 15.3%, 21.0% and 1.7% of patients, respectively. Concomitant use of diuretics and hypnotics was reported in 11.4% and 2.6% of patients, respectively. Small , medium , and high fluid intake was reported in 7.2%, 72.9% and 18.6% of patients. Use of alcoholic beverages on the evening prior to the office visit was reported by 24.0% of patients.

    At baseline prior to treatment, patients had an average IPSS of 19.5 ± 5.9 points, a Qmax of 11.5 ± 3.7 ml/s, a PVR of 69.6 ± 48.7 ml, and a PSA of 2.6 ± 2.2 ng/ml. The patients had 2.8 ± 1.0 nocturia episodes/night based upon question 7 of the IPSS 01, 2, 3, 4, and 5 nocturnal voids were reported by 425, 1931, 2160, 982, and 241 men, respectively. The dsQoL was 3.7 ± 1.2 points, the NQoL 44.5 ± 19.3 points, the NQoL-sleep 51.7 ± 20.8 points, and the NQoL-bother 48.3 ± 22.2 points . All pairwise correlations between IPSS, number of nocturnal voids, dsQoL, NQoL, NQoL-sleep, and NQoL-bother were moderate to strong .

    Factors Associated With Nocturia

    What is benign prostatic hyperplasia (BPH) and how is it treated?

    The presence and extent of nocturia is associated with age and correlated with the overall IPSS . Nocturia is also associated with an impaired QoL . Such correlation between nocturia and QoL has not only been found men with LUTS but also in cancer patients undergoing chemotherapy . The associations between number of nocturia episodes and overall IPSS or dsQoL were confirmed in the present study moreover, we show that number of nocturia episodes is also associated with a lower Qmax and a greater PVRalthough the effect appears smaller than that for QoL scores. As number of nocturia episodes was not associated with PSA in our study and PSA is a proxy for prostate size , this implies that prostate size is not associated with number of nocturia episodes either. A lack of correlation between of prostate size and number of nocturnal voids was also reported by others in direct comparison of the two parameters .

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    Factors Associated With Nocturia At Baseline

    Table 4 Effect sizes as estimated in general linear models for associations of explanatory variables on the dependent variable total NQoL at baseline.

    Figure 2 Effect sizes of number of nocturnal voids on the dependent variables NQoL, NQoL-sleep, NQoL-bother, dsQoL, IPSS, Qmax, and PVR effect sizes for PSA were not calculated because it was the only dependent variable with p 0.01. Data from the models that did not include nocturnal voids are shown in the .

    Figure 3 Effect sizes of presence of diabetes and fluid intake on the dependent variables NQoL, NQoL-sleep, NQoL-bother, dsQoL, and IPSS effect sizes for other dependent variables were not calculated because p 0.01 within the model. Data are derived from the models that included number of nocturnal voids as explanatory variable data from models not including it are shown in the .

    History And Physical Examination

    In men with bothersome lower urinary tract symptoms, a history should be performed to establish the severity of symptoms, evaluate for causes other than BPH , and identify contraindications to potential therapies. The American Urological Association Symptom Index is a validated seven-question instrument that can be used to objectively assess the severity of BPH.6

    Differential Diagnosis of Lower Urinary Tract Symptoms in Men

    Clinical finding

    Differential Diagnosis of Lower Urinary Tract Symptoms in Men

    Clinical finding

    American Urological Association Symptom Index

    Figure 1.

    American Urological Association Symptom Index to assess severity of benign prostatic hyperplasia . A score of 7 or less indicates mild BPH a score of 8 to 19 indicates moderate BPH a score of 20 to 35 indicates severe BPH.

    Adapted with permission from American Urological Association. Guideline on the management of benign prostatic hyperplasia . http://www.auanet.org/guidelines/bph.cfm. Accessed September 19, 2007.

    American Urological Association Symptom Index

    Figure 1.

    American Urological Association Symptom Index to assess severity of benign prostatic hyperplasia . A score of 7 or less indicates mild BPH a score of 8 to 19 indicates moderate BPH a score of 20 to 35 indicates severe BPH.

    Adapted with permission from American Urological Association. Guideline on the management of benign prostatic hyperplasia . http://www.auanet.org/guidelines/bph.cfm. Accessed September 19, 2007.

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    C Data Abstraction And Data Management

    Data fields to be extracted will include author, year of publication, sponsorship, setting, subject inclusion and exclusion criteria, intervention and control characteristics, sample size, follow-up duration, participant baseline age, race, and AUA/IPSS scores, and results of primary outcomes and adverse effects. Relevant data will be extracted into web-based extraction forms created in Microsoft Excel. Data will be analyzed in RevMan 5.3 software.19 Data will be extracted to evidence and outcomes tables by one investigator and reviewed and verified for accuracy by a second investigator.

    Search Strategy And Study Selection

    Benign Prostatic Hyperplasia

    A systematic review was performed according to the Cochrane systematic reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist .

    A comprehensive search of the medical literature was performed, with no restrictions on the publication language or publication status. The search was conducted to find relevant studies from MEDLINE , EMBASE , Google Scholar, and individual urological journals. The latest search date of all databases was October 2017.

    Terms used included: oral desmopressin, Nocturia, and benign prostatic hyperplasia and LUTS.

    Medical Subject Headings phrases included:

    • AND Nocturia)
    • AND Nocturia) AND desmopressin)

    Inclusion criteria were men being treated for LUTS with nocturia, defined as 1 voids/night. We excluded trials of primary or secondary enuresis both in children and adults.

    To assess the risk of bias, two reviewers independently identified all potential studies that adhered to the inclusion criteria for full review. The studies selected for inclusion were independently selected by the reviewers. Disagreement between the extracting authors was resolved by consensus or referred to the third author .

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    Heart Healthy = Prostate Healthy

    Virtually any lifestyle change found to be heart healthy has been shown to reduce the risk or progression of BPH, including maintaining normal blood pressure, blood sugar, and cholesterol levels and a healthy weight or waist size, eating a healthy diet, and exercising. Alpha- blockers are the top-selling drug class used to treat BPH they work by relaxing the prostate. They were originally derived from blood pressurelowering medicines because men reported peeing better when their high blood pressure was reduced. Bam!

    Medical And Financial Consequences Of Nocturia

    Nocturia is not only bothersome for the individual but can also have a profound impact on health and health care. Nocturia has been identified as the leading cause for sleep disturbance and sleep fragmentation, causes daytime fatigue, impacts daily activities, and deteriorates psychomotor performance, cognitive function and mood . Nocturia can also cause depression, immune suppression, increases vulnerability for cardiovascular diseases and the development of diabetes mellitus . Additionally, nocturia significantly increases accidents, falls and fractures . The costs associated with nocturia are tremendous and alarming. Nocturia can cause direct, indirect and intangible costs . Only the direct annual costs of fractures were estimated to be approximately $1.5 billion in the US and approximately 1 billion in the 15 largest countries of the European Union . Indirect costs of nocturia are for example loss or impairment of work productivity, and those numbers are even more alarming. It was calculated that the annual loss of work productivity due to nocturia amounts for approximately $62.5 billion in the US and approximately 29 billion in the 15 largest countries of the European Union . Therefore, societies must have a fundamental interest to diagnose and treat nocturia to reduce morbidity and costs.

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    Body Size Through The Life

    Despite growing interest in a life-course approach to disease causation, few studies have examined how early-life factors or changes in risk factors may alter risk of BPH-related outcomes. This information is critical for chronic conditions as it provides key information on when interventions should be targeted. In our analyses, we found a clear association between gaining large amounts of weight and risk of nocturia, similar to findings from one , but not another study of weight change and incident BPH-related outcomes. Specifically, in the study by Mondul et al., weight gain from age 21 was significantly associated with risk of moderate or worse LUTS only among men who gained at least 40 lbs, and with progression to severe LUTS among those who gained at least 30 lbs . By contrast, Gupta et al., did not observe an association between weight change per decade and the development of BPH . Together, these findings suggest that a sizeable weight gain of at least 3040 lbs throughout the life-course is needed before the risk for LUTS increases.

    Effect Of Tadalafil On Luts In Patients With Nocturia

    Symptoms of Prostate Gland Enlargement | Benign Prostatic Hypertrophy (BPH)

    Overall, the IPSS storage subscore and IPSS-QoL score were significantly improved at week 4 and continued to improve throughout the treatment period . However, the IPSS voiding subscore gradually decreased but did not change significantly throughout the treatment period . In new patients, the effects of tadalafil on the IPSS total scores and subscores were almost the same as the effect overall .

    Fig. 2.

    Effect of tadalafil on IPSS total score , IPSS voiding subscore , IPSS storage subscore , and IPSS QoL score in all patients. Data are mean ± SD. * p< 0.05, ** p< 0.01, compared with baseline.

    Qmax and postvoid residual urine volume improved numerically but did not change significantly with tadalafil treatment . The IIEF5 total score did not change throughout the treatment .

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    The Clinical Index And Results Of 3

    The relationship between NUV, NPi, and evening drinking volume 4h before bedtime drinking volume and other indices

    The relationship between NUV and evening drinking volume and 4h before bedtime drinking volume were related. NPi and maximum urination volume and morning urine volume were related, but there was no correlation between NPi and prostate volume, age, LUTS duration, or I-PSS score.

    Table 1 Clinical indices and nocturia-related parameters in patients with BPHFig. 1

    The relationship between NUV and Evening drinking volume. 1) X axis caption: Evening drinking volume . 2) Y axis caption: NUV

    Fig. 2

    The relationship between NUV and before fall asleep 4h drinking volume. 1) X axis caption: 4-h before bedtime drinking volume . 2) Y axis caption: NUV

    The comparison of evaluation indices between drug treatment and placebo treatment groups for patients with BPH

    Eighty patients were randomized to the drug treatment and 68 patients were randomized to the placebo treatment. The I-PSS score, storage symptom score, voiding symptom score, quality of life score, frequency of daytime urination, maximum urine volume, and morning urine volume were statistically significant between both groups. However, the frequency of nocturia score and nocturnal urine volume did not change significantly.

    Table 2 Comparison of evaluation indices after treatment in patients with BPH and nocturia

    Data statistics between the NP group and the non-NP group


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