Nocturia

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Nocturia
ICD-10 R35.
ICD-9 788.43

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Editor-In-Chief: Steven C. Campbell, M.D., Ph.D., Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic. You can email Dr. Campbell by clicking here. Office phone: 216-444-5595.; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1]

Overview

Nocturia (derived from Latin nox, night, and Greek [τα] ούρα, urine), also called nycturia (Greek νυκτουρία), is the need to get up during the night in order to urinate, thus interrupting sleep. Its occurrence is more frequent in the elderly. Nocturia could result simply from too much liquid intake before going to bed, or it could be a symptom of a larger problem, such as chronic renal failure, urinary incontinence, Interstitial Cystitis, diabetes, benign prostatic hyperplasia, Ureteropelvic junction obstruction[1] or prostate cancer.

Pathophysiology

Causes

Causes by Pathogenesis

 
 
 
 
 
 
 
 
 
Causes of Nocturia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Due to Hormonal imbalance
 
 
 
 
 
 
 
 
Due to Vesical problems
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Global Polyuria
 
Nocturanl Polyuria
 
Sleep disorders
 
 
 
 
Bladder storage disorders

Causes Due to Hormonal Imbalance

Global Polyuria Nocturnal Polyuria Sleep disorders

Defined as a 24-hour urine volume that exceeds 3 liters per day (or 40 mL per kg).The common causes of global polyuria are

Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. Nocturnal polyuria may be due to age-related changes in the secretion and action of arginine vasopressin (AVP). There is a diurnal periodicity in AVP release in young, healthy subjects, with higher AVP plasma levels in the evening contributing to decreased nighttime urine output.The diurnal variation in AVP release is absent in many older people. Compared with the normal patients, nocturia patients have a nocturnal decrease in AVP level. Other causes of nocturnal polyuria include diseases such as

Sleep disorders have been demonstrated to be a frequent cause of nocturia in men younger than 50 years and in women with symptoms of daytime overactive bladder syndrome. Primary sleep disorders may result in nocturia either because of hormonal changes related to sleep-disordered breathing or due to patient misperception of the reason for awakening due to the sleep disturbance but recall this as an awakening to void. e.g.

OSA may also cause nocturnal polyuria by release of atrial natriuretic peptide (ANP).

Causes Due to Vesical Problems

Bladder storage disorder

Reduced bladder capacity or impaired bladder function results in low-volume voids. Most common causes of low-volume bladder voids are

Causes by Organ System

Cardiovascular Heart failure
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Bicalutamide, Cardiac glycosides, Demeclocycline, Diuretics, Excessive vitamin D intake, Lithium, Methoxyflurane, Phenytoin, Propoxyphene, Tiagabine
Ear Nose Throat No underlying causes
Endocrine Liver failure
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Interstitial cystitis, Recurrent UTI
Musculoskeletal/Orthopedic No underlying causes
Neurologic Detrusor hyperactivity, Diabetes insipidus, Neurogenic bladder , Parkinson disease, Restless leg syndrome, Urge incontinence
Nutritional/Metabolic Diabetes, Obesity
Obstetric/Gynecologic No underlying causes
Oncologic Prostate cancer
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anxiety disorders, Depression, Obstructive sleep apnea, Primary polydipsia
Pulmonary No underlying causes
Renal/Electrolyte Chronic renal failure, Diabetes insipidus, Nephrotic syndrome
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic Benign prostatic hyperplasia, Bladder outlet obstruction, Detrusor hyperactivity, Granulomatous prostatitis, Interstitial cystitis, Neurogenic bladder, Prostate cancer, Ureteropelvic junction obstruction
Miscellaneous Learned voiding dysfunction, Venous insufficiency

Causes in Alphabetical Order


References

See also


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