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ABSTRACT: BACKGROUND: Nocturnal polyuria (NP) is common in older men and can lead to nocturia. However, no longitudinal data are available on the natural history of NP. OBJECTIVE: To determine prevalence, incidence, and resolution rates of NP. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal, community-based study was conducted among 1688 men aged 50-78 yr in Krimpen aan den IJssel, The Netherlands (reference date: 1995), with planned follow-up rounds at 2, 4, and 6 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: NP was determined with frequency-volume charts. Two definitions of NP were used: (1) a nocturnal urine production (NUP) of >90ml/h (NUP90) and (2) the nocturnal voided volume plus first morning void being >33% of the 24-h voided volume (NUV33). Nocturia was defined as two or more voids per night. We determined the prevalence of NP at each study round. At first follow-up, we determined the incidence in men without baseline NP and the resolution in men with baseline NP. Prevalence of NP in men with or without nocturia was also determined. RESULTS AND LIMITATIONS: At baseline, the prevalence of NUP90 was 15.0% and increased to 21.7% after 6.5 yr, whereas the prevalence of NUV33 was 77.8% at baseline and 80.5% after 6.5 yr. At 2.1 yr of follow-up, the incidences of NUP90 and NUV33 were 13.6% and 60.3%, respectively, and the resolution rates were 57.0% and 17.8%, respectively. Because of this fluctuation in NP, no reliable long-term incidences could be calculated. At baseline, NUP90 was prevalent in 27.7% of men with nocturia and in 8.0% of those without nocturia. At baseline, NUV33 was prevalent in 91.9% of men with nocturia and in 70.1% of men without nocturia. CONCLUSIONS: Due to the fluctuation of NP, it is advisable to first determine its chronicity and cause before starting treatment. Because of the high prevalence of NP in men without nocturia, NUV33 should be reconsidered as a discriminative definition of NP.
European urology 10/2012; · 7.67 Impact Factor
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ABSTRACT: BACKGROUND: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey. METHODS: A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure. RESULTS: 399 of 918 invite GPs (43%) returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16%) indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only) and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure. CONCLUSION: One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia.
BMC Family Practice 07/2012; 13(1):68. · 1.80 Impact Factor
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ABSTRACT: Although nocturia seems to be related to increased mortality in older men, it is unclear whether this is an independent association. Therefore, we studied the association of nocturia and mortality in community dwelling older men.
A longitudinal, population based study was conducted among 1,688 men 50 to 78 years old. Recruitment started in 1995. At baseline all men completed a questionnaire and a 3-day frequency-volume chart. Nocturnal voiding frequency was derived from the frequency-volume chart and nocturia was defined as 2 or more voids per night. In 2010 all general practitioners' patient records were checked for possible date of death. Univariable and multivariable Cox regression analyses were performed. A subanalysis was performed to determine the effect of 3 longitudinal nocturia patterns (ie incident, persistent or transient/resolved) on the mortality rate.
A total of 1,114 men were eligible for analysis. Median followup was 13.4 years (quartiles 1 to 3: 10.3-14.1) for a total of 12,790 person-years of followup. Univariably nocturia was associated with an increased mortality rate (HR 1.63, 95% CI 1.20-2.21, p = 0.002). After correction for possible confounding factors nocturia had no significant influence on mortality (p = 0.838) in contrast to age, chronic obstructive pulmonary disease, smoking and hypertension (all p <0.05). Men with persistent nocturia had the highest mortality rate compared to those without nocturia. However, this association was not significant (p = 0.083).
In an analysis based on frequency-volume chart data, the association between nocturia and mortality was explained by confounding factors, predominantly age. Furthermore, the mortality risk was not associated with the 3 nocturia patterns.
The Journal of urology 03/2012; 187(5):1727-31. · 4.02 Impact Factor
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ABSTRACT: Nocturia is a highly prevalent and bothersome symptom that might (spontaneously) resolve. However, longitudinal data are not available on the incidence and resolution of nocturia assessed with frequency-volume charts. In this study we determined the prevalence, incidence and resolution rates of nocturia assessed by frequency-volume charts, and compared nocturnal voiding frequency over time as assessed by frequency-volume charts and questionnaires.
A longitudinal, population based study was conducted among 1,688 men 50 to 78 years old with followup rounds at 2.1, 4.2 and 6.5 years. Nocturnal voiding frequency was determined with frequency-volume charts and, for comparison purposes, with a question from the International Prostate Symptom Score. Nocturia was defined as nocturnal voiding frequency 2 or greater. Prevalence, incidence and resolution rates were also determined.
At the 2.1-year followup the incidence rate was 23.9% and the resolution rate was 36.7%. The incidence rate was highest in the oldest group (70 to 78 years) and lowest in the youngest (50 to 54 years), whereas the resolution rate was highest in the group 55 to 59 years old and lowest in the oldest group. Because of the high resolution rate, no reliable incidence rates can be calculated. Despite fluctuation, the prevalence of nocturia increased with age and over time (from 34.4% to 44.7% for the total group, p <0.05). Men who had a frequency-volume chart-nocturnal voiding frequency less than International Prostate Symptom Score-nocturnal voiding frequency (6% of the population) more often had this later on.
In this population frequency-volume chart assessed nocturia shows considerable fluctuation. Nevertheless, prevalence increases over time and with increasing age. Men who once had frequency-volume chart-nocturnal voiding frequency less than International Prostate Symptom Score-nocturnal voiding frequency are more likely to have this again. Therefore, frequency-volume charts as well as the International Prostate Symptom Score should be used when evaluating nocturia.
The Journal of urology 09/2011; 186(5):1956-61. · 4.02 Impact Factor
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ABSTRACT: To evaluate the practice of continuous palliative sedation after the introduction of a national guideline.
Investigation by questionnaire.
In 2008, 1580 physicians were asked to fill out a questionnaire regarding the last patient for whom they had prescribed continuous sedation until death.
The response was 38% (n = 606). Eighty-two percent of the respondents were aware of the national guideline. Dyspnoea, pain and physical exhaustion were most often mentioned as the decisive indications for continuous sedation. The decision to use sedation was discussed with all mentally competent patients; in 18% of these cases, the patients had only been informed of the decision. Life expectancy at the start of continuous sedation was estimated to be less than 2 weeks in 97% of the cases. In 14% of the cases, the physicians felt pressured to start the sedation, predominantly by patients and relatives. Physicians were present at the start of sedation in 81% of the cases. Midazolam was used to induce sedation in 92%, and 41% of the physicians estimated that continuous sedation had hastened death to some extent. Most physicians believed that their patients' symptoms had been adequately relieved by continuous sedation, that the relatives were satisfied and that the quality of dying had been good.
Continuous sedation practice in the Netherlands largely reflects the recommendations of the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation, as well as the possible life-shortening effect of continuous sedation as perceived by some of the physicians.
Nederlands tijdschrift voor geneeskunde 01/2011; 155:A2857.
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ABSTRACT: Although functional bladder capacity, as expressed by maximum voided volume and other frequency-volume chart parameters, are important determinants of lower urinary tract symptoms, to our knowledge no population based data are available on changes in voided volume. We determined changes in and determinants of voided volume and voiding frequency with advancing age and with time, as measured by frequency-volume charts.
We performed a longitudinal, population based study in 1,688 men 50 to 78 years old with followup at 2.1, 4.2 and 6.5 years. Data were obtained using frequency-volume charts for maximum, 24-hour and average voided volume, and 24-hour voiding frequency as well as physical and urological measurements, and self-administered questionnaires. We used a linear mixed effect model to determine factors predicting volume changes.
Median maximum and average voided volume decreased with time from 400 to 380 and 245 to 240 ml, respectively, and were smaller in older age groups while 24-hour voided volume showed no change. The 24-hour voiding frequency increased with time and with advancing age. Maximum, 24-hour and average voided volumes were positively related to alcohol intake. Maximum and average voided volumes were negatively related to higher age at baseline and the passage of time. Hypertension, diuretics and post-void residual volume were related to higher 24-hour voided volume.
In older men maximum and average voided volume show a small but statistically significant decrease with time and with advancing age while 24-hour voided volume does not. Factors predicting the change in maximum or average voided volume are alcohol intake and higher age.
The Journal of urology 11/2010; 185(1):213-8. · 4.02 Impact Factor
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Archives of internal medicine 07/2010; 170(14):1271-4. · 11.46 Impact Factor
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ABSTRACT: We determined if and to what extent longitudinal changes in lower urinary tract symptoms are related to disease specific and generic quality of life in men.
A longitudinal, population based study with a followup of 4.2 years was done in 1,688 who were 50 to 79 years old. Data were collected through self-administered questionnaires, including the Sickness Impact Profile (3 domains), Inventory of Subjective Health, International Prostate Symptom Score (I-PSS) and Benign Prostatic Hyperplasia Impact Index. Moreover, they completed various physical and urological measurements. Mean I-PSS and quality of life scores at baseline and followup were analyzed for certain subgroups. Multiple linear regression was used to determine the change in quality of life in relation to baseline I-PSS, I-PSS changes between baseline and followup, and age.
Although mean I-PSS increased with time, the average generic quality of life improved and almost a third of the men reported better disease specific quality of life. Multiple linear regression revealed that disease specific quality of life was associated with I-PSS at baseline, changes in I-PSS between baseline and followup, and age. However, generic quality of life scores were not associated with these parameters.
Changes in lower urinary tract symptoms severity had little impact on disease specific quality of life in 50 to 79-year-old men or on generic quality of life during the 4.2-year followup.
The Journal of Urology 10/2005; 174(3):1055-8. · 3.75 Impact Factor
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ABSTRACT: To describe loss to follow-up (LTFU) in a longitudinal community-based study on urogenital tract dysfunction in older men.
A cohort study of men recruited from a Dutch municipality was performed. A baseline study and two follow-up rounds--all with questionnaires and additional measurements--were performed with, on average, 2.1-year intervals. Baseline characteristics were compared between participants and non-participants in the first and in the second follow-up study.
The response rates in the first and in the second follow-up were 78.0 and 80.0%, respectively. Various characteristics were found to be related to LTFU (i.e., more than 5% difference in response rate). Lower urinary tract symptoms were related to LTFU in the first and second follow-up. Sexual dysfunction was related to LTFU only in the second follow-up. Adjustment for confounders yielded odds ratios for the primary outcome variables (lower urinary tract symptoms, sexual dysfunction, and health status) that approximated the value of 1. LTFU according to these variables was different in men with and without other chronic illnesses.
LTFU seems not to be related to the primary outcome variables in this study. Describing response patterns in longitudinal studies is important, especially in studies involving older participants, as often is the case in urological research.
Urologia Internationalis 02/2005; 75(1):30-7. · 0.99 Impact Factor
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Journal of the American Geriatrics Society 08/2003; 51(7):1041-2. · 3.74 Impact Factor
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The American Journal of Medicine 07/2003; 114(8):706; author reply 706. · 5.43 Impact Factor
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European Urology 03/2003; 43(2):204; author reply 205. · 8.49 Impact Factor
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New England Journal of Medicine 02/2003; 348(2):170-1; author reply 170-1. · 53.30 Impact Factor
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ABSTRACT: To describe the normal values for nocturnal urine production and its determinants, as well as the relation between nocturnal urine production and voiding frequency.
Data were collected from 1688 men aged 50 to 78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction, or negative advice from their general practitioner. Measurements included self-administered questionnaires, a 3-day frequency-volume chart, transrectal ultrasonography of the prostate, uroflowmetry, and postvoid residual urine volume measurement. The mean nocturnal urine production was computed from the frequency-volume charts. Linear regression analyses were performed to determine associated factors for nocturnal urine production. Areas under the receiver operating characteristic curves were used to describe the discriminative value of nocturnal urine production on nocturnal voiding frequency. A cutoff value for "increased" nocturnal urine production was defined using logistic regression analysis.
The nocturnal urine production was 60.6 mL/hr for the total study population; it increased with age and was significantly higher in men with 24-hour polyuria. Nocturnal urine production was on average higher in men with increased nocturnal voiding frequency, but had only a reasonable discriminative value on nocturnal voiding frequency (areas under receiver operating characteristic curve of 0.71 and 0.76). Nocturnal urine production exceeding 90 mL/hr is suggested as abnormal.
On average, nocturnal voiding frequency is indicative of nocturnal urine production. However, nocturnal urine production is only a modest discriminator for increased nocturnal voiding frequency. Therefore, the use of nocturnal urine production as an explanatory variable for nocturnal voiding frequency in daily practice is of little value.
Urology 11/2002; 60(4):612-6. · 2.43 Impact Factor
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ABSTRACT: We evaluated circadian urine production and its determinants in a large population based sample of older men.
We collected data on 1,688 men 50 to 78 years old, without radical prostatectomy, prostate or bladder cancer, neurogenic bladder disease or negative advice from their general practitioner, recruited from the population of Krimpen, the Netherlands. Measurements consisted of self-administered questionnaires, including the International Prostate Symptom Score, a 3-day frequency-volume chart, transrectal prostatic ultrasound, uroflowmetry and post-void residual volume. Hourly urine production was determined and urine production day-to-night ratio was calculated from the frequency-volume chart.
Men younger than 65 years showed a clear circadian urine production pattern, whereas in older men this pattern was less clear. Smoking, use of diuretic drugs, post-void residual and 24-hour polyuria reinforced the circadian pattern, in favor of daytime urine production. The urine production day-to-night ratio was not associated with prostate enlargement, reduced urinary flow rate, body weight, hypertension, cardiac symptoms, diabetes mellitus, use of antidepressants, cardiac or hypnotic drugs.
Urine production in men younger than 65 years showed a clear circadian pattern in contrast to men older than 65 years. These data can be used as a reference when describing urine production patterns in select populations. In daily practice frequency-volume charts can be used to determine urine production. This method is inexpensive, easy to use and provides valid information on urine production in a natural environment.
The Journal of Urology 11/2002; 168(4 Pt 1):1453-7. · 3.75 Impact Factor
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ABSTRACT: To study health status and its correlates in older men with and without lower urogenital tract dysfunction.
Cross-sectional population-based study on 1688 men aged 50-78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction or a negative advice from their general practitioner. Data were collected through self-administered questionnaires, including Sickness Impact Profile (SIP, three domains), Inventory of Subjective Health (ISH), International Prostate Symptom Score (IPSS) and International Continence Society (ICS) Male Sex questionnaire, medication use, socio-economic and lifestyle factors. Additional information was collected by measurement of blood pressure, transrectal ultrasonography of the prostate and uroflowmetry. Four health status domains were analyzed using the ISH and three domains of the SIP. Lower urinary tract symptoms (LUTS) were categorised using IPSS, erectile and ejaculatory dysfunction were defined using the ICS questionnaire.
All urogenital characteristics and parameters were related to at least two of the health status domains. Multivariate regression analyses yielded that LUTS and cardiac symptoms were associated with suboptimal scores of all four domains. Chronic obstructive pulmonary disease and drugs for abdominal symptoms were related to three domains; erectile and ejaculatory dysfunction, muskuloskeletal or psycho(ana)leptic drugs and marital status to two domains.
The impact of LUTS on health status was equally important as the impact of cardiac symptoms. The impact of sexual dysfunction was smaller than expected. Longitudinal studies are needed to determine how health status and illnesses interact.
European Urology 07/2002; 41(6):602-7. · 8.49 Impact Factor
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British Journal of General Practice 05/2002; 52(477):329. · 1.83 Impact Factor
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ABSTRACT: Objectives. To determine the normal values of voided volumes and explore the relation between bladder capacity and lower urinary tract symptoms (LUTS) in elderly men.Methods. Data were collected from 1688 men 50 to 78 years old recruited from the population of Krimpen aan den IJssel, The Netherlands. Measurements included self-administered questionnaires (including the International Prostate Symptom Score), a 3-day frequency volume chart, transrectal ultrasonography of the prostate, uroflowmetry, and postvoid residual volume determination.Results. The 24-hour voided volumes were independent of age (median 1506 mL; 25th to 75th percentiles 1160 to 1950). The average volume per void and functional bladder capacity (FBC, defined as the largest single voided volume) declined with advancing age. Moreover, FBC was lower in men with a reduced maximum flow rate (less than 15 mL/s) and independent of the postvoid residual volume. Multivariate analyses showed no significant effect of prostate enlargement on the FBC. FBC was strongly related to LUTS: a low FBC coincided with higher International Prostate Symptom Scores. Multivariate logistic regression analyses revealed that the presence of moderate to severe symptoms (International Prostate Symptom Score greater than 7) was independent of prostate volume, but dependent on age, a reduced flow rate, postvoid residual volume, and FBC.Conclusions. Prospective studies are needed to establish the causal relation between FBC and LUTS. Frequency volume charts are a valid, easy-to-use, noninvasive method to determine FBC as an aspect of urinary tract (dys)function in the evaluation of men with LUTS and to determine treatment options for LUTS.
Urology.
