Abstract
Objective: We aimed to compare the effect of urologists’ routine approach and standardized approach on disease management and treatment results in patients suffering from nocturia.
Material and Methods: The study was designed as a non-randomized prospective cohort study between March and July 2023. In the first stage, the routine clinical approach of 6 urology specialists was evaluated. Demographic data, comorbidities, baseline nocturia number, quality of life, and multidisciplinary approach preference of the patients were recorded (Group 1). In the second stage, the patients’ demographic data, comorbidities, and additionally the voiding diary and “Targeting the individual’s Aetiology of Nocturia to Guide Outcomes” (TANGO) questionnaire were questioned (Group 2). All patients were re-evaluated in the first month of the treatments/recommendations given. The difference in the multidisciplinary approach and the change in the number of nocturia and the quality of life of the patients were compared between the two approaches.
Results: Forty-seven patients were included in each group. The demographic and clinical characteristics of the patients in both groups were statistically similar. Charlson’s comorbidity index was higher in Group 2 (p=0.01). The multidisciplinary treatment approach was at a higher level in Group 2 (59.6% vs 8.5%, p=0.001). While the average number of nocturia decreased from 4.6 to 2.19 in group 1, it decreased from 5.15 to 1.21 in group 2. In the first month, the number of nocturia and quality of life scores were lower in group 2. The decrease in the average number of nocturia and quality of life in group 2 was statistically significantly higher than in group 1.
Conclusion: In the approach to nocturia, questioning comorbidities and applying multidisciplinary management provides more meaningful results in nocturia treatment and increase the quality of life.
Ethical Statement
Local ethical board approval was also granted (2023/03-25).
Supporting Institution
Kutahya Health Sciences University Ethical Board
References
- 1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A, Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. https://doi.org/10.1002/nau.10052.
- 2. J.N. Cornu (Chair), M. Gacci, H. Hashim, T.R.W. Herrmann, S. Malde, C. Netsch, M. Rieken, V. Sakalis, M. Tutolo, Guidelines Associates: M. Baboudjian, N. Bhatt,, M. Creta, M. Karavitakis, L. Moris. EAU Guidelines on the Management of Non-neurogenic Male LUTS [Internet]. Uroweb - European Association of Urology. 2023 [cited 2024 Jan 16]. Available from: https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/chapter/citation-information.
- 3. Marshall SD, Raskolnikov D, Blanker MH, Hashim H, Kupelian V, Tikkinen KAO, Yoshimura K, Drake MJ, Weiss JP, International Consultations on Urological Diseases. Nocturia: Current Levels of Evidence and Recommendations From the International Consultation on Male Lower Urinary Tract Symptoms. Urology. 2015;85:1291-1299. https://doi.org/10.1016/j.urology.2015.02.043.
- 4. Bower WF, Rose GE, Ervin CF, Goldin J, Whishaw DM, Khan F. TANGO - a screening tool to identify comorbidities on the causal pathway of nocturia. BJU Int. 2017;119:933-941. https://doi.org/10.1111/bju.13774.
- 5. Culha MG, Culha Y, Buyukyilmaz F, Turan N, Bower W. “TANGO” nocturia scanning tool: Turkish validity and reliability study. Low Urin Tract Symptoms. 2021;13:88-92. https://doi.org/10.1111/luts.12336.
- 6. Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, et al. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn. 2019;38:478-498. https://doi.org/10.1002/nau.23939.
- 7. Tyagi S, Chancellor MB. Nocturnal polyuria and nocturia. Int Urol Nephrol. 2023;55:1395-1401. https://doi.org/10.1007/s11255-023-03582-5.
- 8. Voyvoda B. Can We Use the Silodosin as Second Line Treatment of Benign Prostate Hyperplasia? Grand J Urol [Internet]. [cited 2024 Jan 28];1. doi: 10.5222/GJU.2021.10820.
- 9. Gravas S, Manuel-Palacios J, Chavan C, Roehrborn CG, Oelke M, Averbeck MA, Biswas A, García LM, Mohamed K, Cortes V. Modeling study of the effect of placebo and medical therapy on storage and voiding symptoms, nocturia, and quality of life in men with prostate enlargement at risk for progression. Prostate Cancer Prostatic Dis. 2023; https://doi.org/10.1038/s41391-023-00731-w.
- 10. Robinson D, Suman S. Managing nocturia: The multidisciplinary approach. Maturitas [Internet]. 2018 [cited 2024 Jan 19];116:123-129. https://doi.org/10.1016/j.maturitas.2018.08.007.
- 11. Tikkinen KAO, Johnson TM, Tammela TLJ, Sintonen H, Haukka J, Huhtala H, Auvinen A. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol. 2010;57:488-496. https://doi.org/10.1016/j.eururo.2009.03.080.
- 12. Shao I-H, Wu C-C, Hsu H-S, Chang S-C, Wang H-H, Chuang H-C, Tam Y-Y. The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study. Clin Interv Aging. 2016;11:879-885. https://doi.org/10.2147/CIA.S104634.
- 13. Kobelt G, Borgström F, Mattiasson A. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int. 2003;91:190-195. https://doi.org/10.1046/j.1464-410x.2003.04062.x.
Abstract
Amaç: Noktüri şikayeti olan hastalarda ürologların rutin yaklaşımı ile standardize yaklaşımının hastalık yönetimi ve tedavi sonuçlarına etkisini karşılaştırmayı amaçladık.
Gereç ve Yöntem: Çalışma, Mart-Temmuz 2023 tarihleri arasında randomize olmayan prospektif kohort çalışması olarak tasarlandı. İlk aşamada 6 üroloji uzmanının rutin klinik yaklaşımı değerlendirildi. Hastaların demografik verileri, komorbiditeleri, başlangıçtaki noktüri sayısı, yaşam kalitesi ve multidisipliner yaklaşım tercihleri kaydedildi (Grup-1). İkinci aşamada hastaların demografik verileri, komorbiditeleri ve ayrıca işeme günlüğü ve “Sonuçlara Yönelik Bireyin Noktüri Etiyolojisinin Hedeflenmesi” (TANGO) anketi sorgulandı (Grup-2). Verilen tedavilerin/önerilerin ardından tüm hastalar ilk ayda tekrar değerlendirildi. İki yaklaşım arasında multidisipliner yaklaşımdaki fark ile hastaların noktüri sayısı ve yaşam kalitesindeki değişim karşılaştırıldı.
Bulgular: Her gruba 47 hasta dahil edildi. Her iki gruptaki hastaların demografik ve klinik özellikleri istatistiksel olarak benzerdi. Charlson komorbidite indeksi Grup-2’de daha yüksekti (p=0,01). Multidisipliner tedavi yaklaşımı Grup-2’de daha yüksek düzeydeydi (%59,6 vs %8,5, p=0,001). Grup-1’de ortalama noktüri sayısı 4,6’dan 2,19’a düşerken, grup-2’de 5,15’ten 1,21’e düştü. Birinci ayda noktüri sayısı ve yaşam kalitesi skorları grup-2’de daha düşüktü. Grup-2’de ortalama noktüri sayısı ve yaşam kalitesindeki azalma grup-1’e göre istatistiksel olarak anlamlı derecede daha yüksekti.
Sonuç: Noktüriye yaklaşımda komorbiditelerin sorgulanması ve multidisipliner yönetimin uygulanması noktüri tedavisinde daha anlamlı sonuçlar sağlamakta ve yaşam kalitesini arttırmaktadır.
Ethical Statement
Etik kurul onayı alınmıştır. Numara: 2023/03-25
Supporting Institution
Kütahya Sağlık bilimleri üniversitesi etik kurulu
References
- 1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A, Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. https://doi.org/10.1002/nau.10052.
- 2. J.N. Cornu (Chair), M. Gacci, H. Hashim, T.R.W. Herrmann, S. Malde, C. Netsch, M. Rieken, V. Sakalis, M. Tutolo, Guidelines Associates: M. Baboudjian, N. Bhatt,, M. Creta, M. Karavitakis, L. Moris. EAU Guidelines on the Management of Non-neurogenic Male LUTS [Internet]. Uroweb - European Association of Urology. 2023 [cited 2024 Jan 16]. Available from: https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/chapter/citation-information.
- 3. Marshall SD, Raskolnikov D, Blanker MH, Hashim H, Kupelian V, Tikkinen KAO, Yoshimura K, Drake MJ, Weiss JP, International Consultations on Urological Diseases. Nocturia: Current Levels of Evidence and Recommendations From the International Consultation on Male Lower Urinary Tract Symptoms. Urology. 2015;85:1291-1299. https://doi.org/10.1016/j.urology.2015.02.043.
- 4. Bower WF, Rose GE, Ervin CF, Goldin J, Whishaw DM, Khan F. TANGO - a screening tool to identify comorbidities on the causal pathway of nocturia. BJU Int. 2017;119:933-941. https://doi.org/10.1111/bju.13774.
- 5. Culha MG, Culha Y, Buyukyilmaz F, Turan N, Bower W. “TANGO” nocturia scanning tool: Turkish validity and reliability study. Low Urin Tract Symptoms. 2021;13:88-92. https://doi.org/10.1111/luts.12336.
- 6. Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, et al. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn. 2019;38:478-498. https://doi.org/10.1002/nau.23939.
- 7. Tyagi S, Chancellor MB. Nocturnal polyuria and nocturia. Int Urol Nephrol. 2023;55:1395-1401. https://doi.org/10.1007/s11255-023-03582-5.
- 8. Voyvoda B. Can We Use the Silodosin as Second Line Treatment of Benign Prostate Hyperplasia? Grand J Urol [Internet]. [cited 2024 Jan 28];1. doi: 10.5222/GJU.2021.10820.
- 9. Gravas S, Manuel-Palacios J, Chavan C, Roehrborn CG, Oelke M, Averbeck MA, Biswas A, García LM, Mohamed K, Cortes V. Modeling study of the effect of placebo and medical therapy on storage and voiding symptoms, nocturia, and quality of life in men with prostate enlargement at risk for progression. Prostate Cancer Prostatic Dis. 2023; https://doi.org/10.1038/s41391-023-00731-w.
- 10. Robinson D, Suman S. Managing nocturia: The multidisciplinary approach. Maturitas [Internet]. 2018 [cited 2024 Jan 19];116:123-129. https://doi.org/10.1016/j.maturitas.2018.08.007.
- 11. Tikkinen KAO, Johnson TM, Tammela TLJ, Sintonen H, Haukka J, Huhtala H, Auvinen A. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol. 2010;57:488-496. https://doi.org/10.1016/j.eururo.2009.03.080.
- 12. Shao I-H, Wu C-C, Hsu H-S, Chang S-C, Wang H-H, Chuang H-C, Tam Y-Y. The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study. Clin Interv Aging. 2016;11:879-885. https://doi.org/10.2147/CIA.S104634.
- 13. Kobelt G, Borgström F, Mattiasson A. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int. 2003;91:190-195. https://doi.org/10.1046/j.1464-410x.2003.04062.x.
Details
| Primary Language | English |
|---|---|
| Subjects | Urology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | January 31, 2024 |
| Submission Date | January 19, 2024 |
| Acceptance Date | January 29, 2024 |
| Published in Issue | Year 2024 Volume: 16 Issue: 1 |
