Lower urinary tract symptoms and their impact on quality of life after successful renal transplantation.
ABSTRACT To investigate lower urinary tract symptoms (LUTS) and their impact on quality of life (QOL) in patients having undergone renal transplantation (RTX).
Forty-three patients (25 males and 18 females; age 20-68 years) undergoing RTX at Hokkaido University Hospital were included in this study. Median follow-up after RTX was 41 months (range 6-184). Pre-transplant dialysis had been carried out in 38 patients (median: 4.3 years, range: 1 month-31 years). All patients were assessed by uroflowmetry (UFM), postvoid residual urine volume (PVR), 24 h bladder diary, and International Prostate Symptom Score (IPSS). QOL score and King's Health Questionnaire (KHQ) were used for the assessment of LUTS-related QOL.
Mean fluid intake volume and urine output volume for 24 h were 2136 mL (1150-3430 mL) and 2446 mL (1336-4733 mL), respectively. Voiding dysfunction assessed by UFM and PVR was observed in 12 patients (28%) showing higher IPSS. QOL score and overall QOL in KHQ were not different between patients with and without voiding dysfunction. Although 19 (49%) had polyuria, 20 (51%) had nocturnal polyuria, which affected nocturia in IPSS as well as sleep/energy disturbances in KHQ compared with patients without nocturnal polyuria.
Patients having RTX frequently present voiding dysfunction and nocturia basically caused by nocturnal polyuria. We should focus on LUTS in these patients to provide an appropriate management.
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ABSTRACT: The study of voiding in men and women has been handicapped by the lack of a normal reference range covering urinary flow rates over a wide range of voided volumes. Normal volunteers (331 males and 249 females) were studied. Each voided once into a calibrated Dantec Urodyn 1000 mictiograph. On a second occasion 282 men and 46 women voided. The maximum and average urine flow rates of the first voids in both sexes were compared with the respective voided volumes. Nomogram charts, in centile form, for both the maximum and average urine flow rates were constructed using statistical transformations of the data. Males showed a significant decline in both urinary flow rates with age, although there was no statistically significant variation in either urine flow rate with respect to first versus repeated voiding. Females showed no statistically significant variation in either urine flow rate with respect to age, parity or first versus repeated voiding. The maximum and average urine flow rates in both sexes showed an equally strong relationship to voided volume. No artificial restriction of voided volume, e.g. minimum 200 ml, appeared appropriate. These nomograms offer reference ranges for both maximum and average urinary flow rates in both sexes covering a wide range of voided volumes (15-600 ml).British Journal of Urology 08/1989; 64(1):30-8.
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ABSTRACT: We investigated the prevalence and nature of lower urinary tract symptoms after renal transplantation. In addition, we studied how these symptoms affect the quality of life and whether function of the lower urinary tract before transplantation was related to postoperative occurrence of lower urinary tract symptoms. Data were gathered by a written questionnaire. The research group consisted of 63 patients who underwent renal transplantation in 1998 at the University Medical Center St Radboud Nijmegen. The control group consisted of 74 patients with nonurological complaints who visited an outpatient clinic at the same university. The most important finding was that patients who underwent renal transplantation needed to void more often than controls, both during the day and at night. After renal transplantation, almost 50% of the patients complained of frequency and 62% nocturia. Patients with a transplant had tended to perceive frequency and nocturia less as problems than those in the control group. No relation was found between the functioning of the lower urinary tract before transplantation, and occurrence of frequency and nocturia after. The amount of fluid intake at the interview was not related to the occurrence of frequency and nocturia. No abnormalities were found regarding bladder evacuation.The Journal of Urology 11/2001; 166(4):1237-41. · 3.70 Impact Factor
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ABSTRACT: Nocturia is a common lower urinary condition in the elderly population and nocturnal polyuria is recognized as a major factor responsible for nocturia. A functional change in osmotic or nonosmotic control regarding the water-salt balance with aging may contribute to nocturnal polyuria. This study evaluated plasma arginine vasopressin secretion function in symptomatic patients with nocturnal polyuria and the impact of mean blood pressure on nocturnal polyuria. A total of 29 patients who had nocturnal polyuria with 3 or more voids nightly and were screened with a 24-hour voiding diary were evaluated for their diurnal rhythm of arginine vasopressin secretion and osmotic response during a 5% hypertonic saline infusion test. Moreover, the relationships between the severity of nocturnal polyuria, ie the nocturnal polyuria index, or mean voided volume and mean blood pressure were assessed. Decreased nocturnal baseline arginine vasopressin according to plasma osmolality was found in 11 patients (38%) and the lack of a diurnal rhythm for arginine vasopressin secretion was observed in high proportion. A positive correlation between plasma arginine vasopressin and plasma osmolality was described with a linear regression line, expressed as arginine vasopressin = 0.27 (plasma osmolality - 285), resulting in a 2 to 3 mmol/l upward shift in the threshold of overall plasma arginine vasopressin secretion, although various osmotic sensitivities in arginine vasopressin secretion were observed in individuals. Mean voided volume increased during the night more than during the day (p <0.0001). A significant positive correlation of mean blood pressure with the mean daytime-to-nighttime single voided volume ratio and the nocturnal polyuria index was found (p = 0.0343 and 0.0109, respectively). An abnormal diurnal variation in arginine vasopressin secretion is highly prevalent in nocturnal polyuria. Moreover, it is relevant to mean blood pressure or sympathetic tone, such that the effects of nonosmotic control seem clinically implicated. Particular emphasis has been applied to the importance of considering comprehensive assessments not only of arginine vasopressin secretion function, but also of the possible underlying cardiovascular condition or hypertension in the treatment modality of nocturnal polyuria.The Journal of Urology 09/2006; 176(2):660-4. · 3.70 Impact Factor