2. Nocturia vescica, prostata o sintomo sistemico ?

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

4. 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

5. 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

6. Tikkinen et al.
Eur Urol 57(3) , 2010

7. 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

8. Definitions van Kerrebroeck et al.
Neurology and Urodynamics 21: , 2002

9. 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

10. Classification
ICI, 2013

11. No abnormalities on FVC

12. 24-h urine volume > 40 ml/kg

13. NPI > 20-33%

14. NBCi > 0

15. Classification
Cornu JN
Eur Urol 62 : 877, 2012

16. Classification
ICI, 2013

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

20. Nocturia insieme a sintomi minzionali

21. come sintomo SISTEMICO
Nocturia
come sintomo SISTEMICO
e non di organo

22. 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

24. Urologo funzionale
sempre più
specialista globale
e non di organo

25. Nocturia vescica, prostata sintomo sistemico ?