Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Main causes of nocturia are 24‐hour polyuria, nocturnal polyuria, decreased bladder capacity and sleep disorder. This study revealed that nocturia is closely related to four factors, namely, 24‐hour urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration and evaluation of all these factors through analysis of bladder diaries is clinically important to decide which is the main contributing factor in patients with nocturia and to determine suitable treatment modality on an individual basis. OBJECTIVE • To determine the relationship between the number of nocturia and 24‐h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration as well as to assess the significance of these factors with respect to eliminating nocturnal voidings in individual patients with nocturia. PATIENTS AND METHODS • Among 532 participants who completed a 3‐day bladder diary between April 2005 and December 2006, the diaries of 450 participants without 24‐h polyuria were analyzed. • Clinical variables such as the number of daytime and night‐time voids, 24‐h urine volume, nocturnal polyuria index, daytime and night‐time maximum voided volumes (MVV), night/day MVV ratio, sleep duration and proportion of night/day urine production rates were obtained from each diary. • Participants were classified into eight groups according to values of three factors: nocturnal MVV, proportion of night/day urine production rates and length of sleep duration. • Each group was divided into three subgroups: non‐nocturics (number of nocturnal voidings is zero), mild nocturics (number of nocturnal voidings is one) and severe nocturics (number of nocturnal voidings is two or more). • The data from non‐nocturics with three normal factors were regarded as the normal control and compared with the variables of the other subgroups using Dunnett’s method. RESULTS • Variables that form the basis of classifying participants into eight groups and corresponding to abnormal factors of each group were statistically significant in all the subgroups of each group. • Furthermore, a significantly increased 24‐h urine volume was found in severe nocturics of the group with three normal factors. • A significantly decreased 24‐h urine volume was found in non‐nocturics of groups with nocturnal polyuria, decreased bladder capacity and both long sleep duration and nocturnal polyuria. • A significantly increased nocturnal MVV and night/day MVV ratio were shown in non‐nocturics and mild nocturics of the groups with nocturnal polyuria and both long sleep duration and nocturnal polyuria. CONCLUSIONS • Because nocturia is a multifactorial disorder and closely related to four factors (i.e. 24‐h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration), the evaluation of all these factors appears to be clinically useful for determining the main contributing factor in patients w...

OBJECTIVE To analyse the relationship between the number of nocturia episodes and other variables obtained from a bladder diary, with special attention to the duration of sleep, as nocturia is closely related to sleep disorders. PATIENTS, SUBJECTS AND METHODS Between April 2005 and December 2006, 532 participants, including both community‐dwelling subjects who underwent a mass screening programme and outpatients who consulted the department of urology, completed a 3‐day bladder diary. Clinical variables, i.e. the number of daytime and night‐time voids, diurnal and nocturnal urine volume, daytime and night‐time maximum voided volume, sleep duration and nocturnal polyuria index (NPi) were obtained from the diary. The variables were assessed by univariate analysis in all participants, and by multiple regression analysis of all participants, males, females, subjects in mass screening and those with no 24‐h polyuria, to determine which variables were independently associated with the number of nocturia episodes. RESULTS Univariate analysis showed a considerable correlation between the nocturia episodes and age, nocturnal urine volume, NPi and sleep duration. On multiple regression analysis, age, nocturnal urine volume, night‐time maximum voided volume and sleep duration were independently related to number of nocturia episodes in all subgroups. CONCLUSIONS Sleep duration was confirmed as an independent factor in nocturia. Sleep conditions, including sleep duration, should be considered when evaluating and treating patients with nocturia.

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A bladder diary that includes a new bladder perception grade was thought to be useful in assessing urinary sensation or incontinence as well as voiding pattern. The causes of symptoms such as urgency or urinary frequency may be different between the Normal, OAB-Dry, and OAB-Wet groups.

Objectives: To assess possible predictors in determining criteria for repeat biopsy in a prostate cancer screening population. Methods: A total of 50 207 men over 55 years-of-age have participated in a prostate cancer screening program in Otokuni, Kyoto, Japan for 12 years. Transperineal systematic biopsy was carried out in case of positive digital rectal examination (DRE) or positive transrectal ultrasonography (TRUS) or a prostate-specific antigen (PSA) value greater than 10.0 ng/mL. For those with a PSA level from 4.1 to 10.0 ng/mL, and negative DRE and TRUS findings, biopsy was indicated only when PSA density (PSAD) was greater than 0.15. The same indication was applied for the repeat biopsy. Results: A repeat biopsy after an interval of more than 2 years was carried out in 140 patients and was positive in 50 (36%) patients. The PSA value at the diagnosis of cancer declined from the initial value in six (12%) patients. On multivariate logistic regression analysis, PSA velocity (PSAV) as well as PSAD and DRE findings at latest screening were independent predictors for positive repeat-biopsy outcome. The odds ratio (95% confidence intervals) of PSAV >0.48, latest PSAD >0.33 and positive latest DRE were 4.17 (1.05-18.5), 4.15 (1.31-14.0), and 3.62 (1.06-13.2), respectively. A combination of three variables defined as positive if any of these were positive, reduced 31% of unnecessary biopsies while missing 8% of low volume, low grade cancers. Conclusions: A combination of latest PSAD, PSAV and positive DRE at latest screening might help to reduce unnecessary repeat biopsies in high-risk patients with an initial negative biopsy.

and the parent-infant relationship index, a validated measurement of the relationship between the child and the parent(s) (Dev Med Child Neurol 2017;59:477-483). They found that both of these had an association on cognitive outcomes, of a similar magnitude to SGA birth. One of their conclusions was that more focus should be spent on optimizing these potentially modifiable social factors through intervention. This seems like an appropriate conclusion, although in our US society, these substantial changes in social outcomes are not easily addressed. Although perhaps with the major cultural shifts that seem to potentially be happening, maybe in fact we will see some improvements in the outcomes for these vulnerable patients.-MEN)

Objective: A joint study was undertaken by the Japanese Society of Renal Cancer to investigate the present status of partial nephrectomy in Japan and to speculate about what may be the indications for partial nephrectomy in patients with renal cell carcinoma. Methods: Data were tabulated for 469 patients from participating medical institutions and various clinical factors were investigated with regard to disease progression (local recurrence and distant metastasis). Results: Disease progression was observed in 21 patients (4.5%). No significant relation to disease progression was observed for sex, laterality, tumor histology, grade and tumor size. Although patients with solitary tumors displayed excellent prognosis irrespective of tumor diameter, patients with multiple tumors displayed a high likelihood of disease progression. Patients older than 77 years old and patients with imperative indication were found to have a poorer prognosis. Conclusion: In patients with solitary tumors, partial nephrectomy can be actively performed , even if the patient displays elective indications and the tumor is >4 cm in diameter. In patients displaying multiple tumors with imperative indications, the decision whether to perform partial nephrectomy should be made by the patients and their physicians after considering the impact on curability and the quality of life.