Nocturnal-Only Voiding Diaries: A Rational Alternative to 24-Hour Diaries for Patients with Nocturia?
Thomas F. Monaghan, MD Candidate, Raymond Khargi, MD, Connelly D. Miller, MD Candidate, Christina W. Agudelo, MD Candidate, Kyle P. Michelson, MD, Syed N. Rahman, MD Candidate, Matthew R. Epstein, MD, Jeffrey P. Weiss, MD.
SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
BACKGROUND: The major etiologies underlying nocturia can be divided into excess urine production (i.e., nocturnal [NP] and global polyuria [GP]) or small bladder capacity (SBC). An assessment of voiding diary data from the hours of sleep alone can, in of itself, support a diagnosis of NP, but the generalizability of nocturnal urinary data to the 24-h period (e.g., in the diagnosis of GP or SBC) remains unclear. This study determines the sensitivity and specificity of nocturnal urinary parameters in diagnosing nocturia owing to GP and SBC.
METHODS: Retrospective analysis of voiding diaries showing ≥1 nocturnal void(s) from men aged ≥18 years at an outpatient urology clinic. GP was defined as a 24-h urine volume >3000 mL. SBC was defined as a 24-h Maximum Voided Volume (MVV) <200 mL. Nocturnal urine production (NUP) >125 mL/h (3000mL divided by 24 hours) and Nocturnal MVV (NMVV) <200 were employed as nocturnal proxies for GP and SBC, respectively.
RESULTS: A total of 483 entries from 288 patients were included. Fifty-eight diaries demonstrated a 24-h urine volume >3000 mL, and 110 diaries reported NUP >125 mL/h, such that NUP >125 mL/h was 71% sensitive and 84% specific for GP. Eighty-nine diaries reported a 24-h MVV <200 mL, and 139 entries demonstrated a NMVV <200 mL, corresponding to a 100% sensitivity and 87% specificity for SBC.
CONCLUSIONS: Beyond its intrinsic utility in diagnosing NP, nocturnal urinary data can predict diagnoses of GP and 24-h SBC with a fair degree of sensitivity and specificity. Nocturnal-only voiding diaries may represent a more patient-centered screening instrument in the initial evaluation of nocturia—particularly in the setting of patient nonadherence or when 24-h diaries are otherwise impractical.
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