Nocturia vescica, prostata o sintomo sistemico ? walter.artibani@univr.it

LOWER URINARY TRACT SYMPTOMS (LUTS) STORAGE SYMPTOMS urgency, frequency, nocturia incontinence VOIDING SYMPTOMS poor stream, hesitancy POSTMICTURITION SYMPTOMS postmicturition dribble sensation of incomplete emptying

Definition ICS, 2002 “The complaint that the individual has to wake at night 1 or more times to void” Report from the standardization sub-committee ICS, 2003 “ The number of voids are recorded during a night’s sleep : each void is preceeded and followed by sleep ICS definition refers to nocturia as a complaint rather than a clinical important condition The word “night” should be replaced by sleep time Definition Abrams P et al. Urology 61(1), 2003 Nocturia THINK TANK and consensus statement from interdisciplinary conference on nocturia Weiss P BJU Int 108 : 6, 2011

Prevalence • Men aged 20–40 years: 2–17% • Women aged 20–40 years: 4–18% • Men aged > 70 years: 29–59% • Women aged > 70 years: 28–62% Cornu JN Eur Urol 62 : 877, 2012

Tikkinen et al. Eur Urol 57(3) 488-496, 2010

QoL and economic impact Nocturia QoL and economic impact Diurnal fatigue Decreased concentration Lower performance at work Accidents (fractures...) Quality of sleep of the partner ≥ 3 voids /night it is associated with higher total medical costs Cornu JN Eur Urol 62 : 877, 2012 Nakagawa H J Urol 183 : 1, 2010

Definitions van Kerrebroeck et al. Neurology and Urodynamics 21:179-183, 2002

Definitions ”Nocturia occurs when the nocturnal urine volume exceeds the maximum voided volume that reflects the functional bladder capacity..." Dani H Nature Reviews 13 : 573, 2016

Classification ICI, 2013

No abnormalities on FVC

24-h urine volume > 40 ml/kg

NPI > 20-33%

NBCi > 0

Classification Cornu JN Eur Urol 62 : 877, 2012

Classification ICI, 2013

Nocturia sintomo isolato con causa sistemica nota Nocturia sintomo isolato senza causa sitemica nota

Nocturia insieme a sintomi minzionali

come sintomo SISTEMICO Nocturia come sintomo SISTEMICO e non di organo

WHITE MATTER DISEASE CIRCUIT 2: BLADDER SENSORY INFORMATION & PREPARATION OF MOTOR RESPONSES CIRCUIT 1: VOID-NO VOID DECISION WHITE MATTER DISEASE CIRCUIT 3: ENVIRONMENT RECOGNITION EMOTIONAL STATE Circuit 1: frontal, involving the medial prefrontal cortex; contextualization of bladder sensory information with precosncious and cosncious control over bladder filling and voiding; the seat of the void/no void decision Circuit 2: midcingulate involving the dACC and adjacent SMA; registration of bladder sensory information and preparation of motor responses Circuit3: subcortical involving refions such as the hippocampal ccomplex; corresponding with the limbic system, pattern/enviromental reocgnition and relating urinary status to emotional state

Urologo funzionale sempre più specialista globale e non di organo

Nocturia vescica, prostata sintomo sistemico ? walter.artibani@univr.it