Development of a multivariate prediction model for nocturia, based on urinary tract etiologies

Olesen TK⁽¹⁾, Denys MA⁽²⁾, Goessaert AS⁽¹⁾, Bruneel E⁽¹⁾, Decalf V⁽¹⁾, Helleputte T⁽³⁾,Paul J⁽³⁾, Gramme P⁽³⁾, Everaert K⁽²⁾

Nocturia, or waking at night at least once to void, is a common and bothersome lower urinary tract symptom (LUTS) that results from an imbalance between functional bladder storage capacity and urine production [1]. Inadequate functional bladder storage results in small voided volumes and can be caused by different underlying conditions, such as urinary tract infections, idiopathic/neurogenic detrusor over activity and bladder outlet obstruction due to benign prostate enlargement (BPE). Increased urinary output, which can be overnight only or during a 24h period, can also develop for a variety of reasons such as heart failure, diabetes insipidus or mellitus, decreased vasopressin levels, venous insufficiency, or obstructive sleep apnea. In order to initiate appropriate treatment, a frequency volume chart (FVC) is recommended as an indispensable tool to subtype nocturia patients according to the underlying etiology: reduced functional bladder capacity (FBC), 24h polyuria, nocturnal polyuria (NP), or combined etiology [2]. Treatments to improve FBC include anticholinergics in patients with detrusor over activity and symptoms of overactive bladder (OAB), whereas recent introduced treatment for OAB, beta-3-agonist stimulates beta-3 receptors, causing smooth muscle relaxation in the bladder and α-blockers or 5α-reductase inhibitors in case of BPE. Therapeutic measures directed to reduce nocturnal urinary output include evening fluid restriction, leg elevation during daytime, timed diuretics, and antidiuretic treatment with desmopressin [3,4]. Despite this knowledge, management of nocturia patients remains to be challenging because unambiguous definitions of NP and reduced FBC are lacking and as there is little evidence in reference to the effect of all possible combinations of treatment modalities in case of a combined etiology of nocturia [2,3,5,6].

Based on a pooled analysis of frequency volume charts of 183 elderly subjects both males and females we developed a multivariate logistic regression model that could differentiate nights with and without nocturia. By identifying the most important determinants for nocturia nights, the mixed etiology of nocturia is recognized. In addition, the effect of influencing any of the parameters can lead to estimating the probability of nocturia free nights using the multivariate model, which is of clinical benefit for the patients.

Click here to go to the paper
Download the pdf version

In the left column of this page, you can find the way to determine if the patient suffers from nocturia.

How to interpret the results ?

The model used to determine wether or not the patient suffers from nocturia is the model specified on the first row of the following table.

How to cite this calculator ?

To cite this calculator, use this reference: "Bastin M⁽³⁾, Olesen TK⁽¹⁾, Denys MA⁽²⁾, Goessaert AS⁽¹⁾, Bruneel E⁽¹⁾, Decalf V⁽¹⁾, Helleputte T⁽³⁾,Paul J⁽³⁾, Gramme P⁽³⁾, Everaert K⁽²⁾ - Online multivariate prediction model for nocturia, based on urinary tract etiologies, http://www.nocturia.dnalytics.com, 2018.".
To cite the scientific work behind this calculator, use this reference: Olesen TK, Denys MA, Goessaert AS, Bruneel E, Decalf V, Helleputte T, Paul J, Gramme P, Everaert K. 2018, Development of a multivariate prediction model for nocturia, based on urinary tract etiologies. International Journal of Clinical Practice

References

1. Weiss JP, Blaivas JG, Blanker MH, et al. 2013, The new England Research Institues, Inc. (NERI) Nocturia Advisory Conference 2012: Focus on outcomes of Therapy. BJU Int. 111(5):700-16.
2. P van Kerrebroeck, H Hashim, T Holm-Larsen, D Robinson, N Stanley, 2010: Thinking beyond the bladder: antidiuretic treatment of nocturia. Int. J Clin. Pract. 64 (6), 807- 816.
3. HK Park, HG Kim, 2013: Current evaluation and treatment of nocturia. Korean J Urol. 54 (8), 492-498.
4. D Raskolnikov, FM Friedman, DJ Etwaru, JP Weiss, 2014: The evaluation and management of persistent nocturia. Curr. Urol. Rep. 15 (9), 439.
5. JL Bosch, K Everaert, JP Weiss, H Hashim, MS Rahnama'i, AS Goessaert et al., 2016: Would a new definition and classification of nocturia and nocturnal polyuria improve our management of patients? ICI-RS 2014. Neurourol Urodyn. 35 (2), 283-287.
6. S Madersbacher, JN Cornu, 2013: Nocturnal polyuria: it's all about definition, and be Patient! Eur Urol. 63 (3), 548-550.