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Purpose: Pathologic upstaging in renal cell carcinoma (RCC) is common and confers a significant risk of poor surgical and survival outcomes. Preoperative predictors of upstaging are of great clinical relevance but empirical evidence specific to racial minorities remains scarce. Methods: National Cancer Database (NCDB) analysis of T3a‐specific upstaging among White, African‐American, Hispanic and Asian Pacific Islander (API) patients with AJCC cT1N0M0 RCC who underwent partial or radical nephrectomy between 2010 and 2015. Independent preoperative predictors of tumour upstaging were identified using multivariate logistic regression analyses. Results: A total of 81 002 patients met the criteria for inclusion (5.6% T3a‐specific upstaging). Increased age, increased Charlson‐Deyo comorbidity index, clinical stages cT1b and unspecified cT1, and increased Fuhrman nuclear grade were identified as independent risk factors for upstaging. Independent protective factors for upstaging were younger age, female sex, African‐American race and papillary, chromophobe, and unspecified RCC histologic subtypes. Significant risk factors and protective factors within individual racial subgroups were highly consistent with those observed in the overall study sample. All independent factors identified on race‐specific subgroup analyses were significant in the same direction relative to the overall study sample. Variables found to be non‐significant in the overall study sample remained non‐significant across all racial subgroup analyses. Conclusion: The present study of nationally representative data found no clinically significant differences in upstaging risk across individual racial subgroups relative to the overall study sample. Preoperative factors that can be used to predict pT3a‐specific tumour upstaging in CT1N0M0 RCC likely persist across different racial groups. [ABSTRACT FROM AUTHOR]

Aims: Nocturia has been increasingly recognized as a potential manifestation of cardiovascular disease. However, the relationship between nocturia and electrocardiographic (ECG) abnormalities has not been studied. This study aims to characterize the diagnostic utility of nocturia in identifying left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc on ECG. Methods: Retrospective analysis of nocturnal voiding frequency and contemporaneous ECG data from consecutive patients evaluated at a university‐based outpatient cardiology clinic. Three sets of three incremental binary multiple logistic regression models controlling for (1) age, (2) sex and race, and (3) body mass index, hypertension, diabetes mellitus, and diuretic utilization were performed to determine whether nocturia was predictive of LVH, LAE, and prolonged QTc. Results: Included patients (n = 143, 77.6% nocturia) were predominantly African‐American (89.5%), female (74.1%), and obese (61.5%), of whom 44.1%, 41.3%, and 27.3% had LVH, LAE, and prolonged QTc, respectively. Older age, African‐American race, obesity, hypertension, diuretic use, LVH, and LAE were significantly associated with nocturia on univariate analysis. No significant differences were observed in the strength of associations between nocturia and LVH, LAE, or QTc prolongation based on age. Nocturia independently predicted LVH in Models I–III (odds ratios [ORs], 2.99–3.20; relative risks [RRs], 1.18 for all, p ≤.046) and LAE in Models I–III (ORs, 4.24–4.72; RRs, 1.21 for all, p ≤.015). No significant associations were observed between nocturia and prolonged QTc. Conclusions: Nocturia may be a risk marker for underlying structural cardiac abnormalities. [ABSTRACT FROM AUTHOR]

Aims: Nocturnal polyuria (NP) and global polyuria (GP) are not mutually exclusive. However, by rate, the common criteria for GP (40 mL/kg/24 hours [117 mL/kg/hour in a 70‐kg individual] or 3000 mL/24 hours [125 mL/h]) are more stringent than those for NP (90 mL/hour during the sleep period or NP index [NPi; nocturnal volume/24‐hour volume] > 0.33 [no minimum rate]). It remains unclear whether total nocturnal urine volume (NUV) may reliably delineate between NP patients with and without comorbid GP. Methods: A clinical database of men with lower urinary tract symptoms was searched for voiding diaries completed by patients reporting greater than or equal to 1 nocturnal void(s). Four separate analyses were performed using all combinations of the two NP and two GP criteria listed above. For each analysis, patients were included if they met the criteria for NP, and then stratified by presence or absence of GP (ie, NP + GP vs isolated NP). Results: Median NUV was greater among patients with NP + GP for all criteria combinations. Sensitivities greater than or equal to 80%/90%/100% for NP + GP were observed at 1275/1230/1085 mL for {NPi > 0.33 + 24‐hour volume > 3000 mL}; 1075/1035/1035 mL for {NPi > 0.33 + 24‐hour volume > 40 mL/kg}; 900/745/630 mL for {NUP > 90 mL/hour + 24‐hour volume > 3000 mL}; and 1074/1035/990 mL for {NUP > 90 mL/hour + 24‐hour volume > 40 mL/kg}. Conclusions: An inordinate NUV among men with NP is fairly sensitive for comorbid GP. In the appropriate clinical setting, nocturnal‐only diaries may suffice in the evaluation and follow‐up of patients with NP, so long as outlying nocturnal volumes prompt a 24‐hour diary/urine collection. [ABSTRACT FROM AUTHOR]

Keywords: nocturnal-only; NOVD; voiding diary EN nocturnal-only NOVD voiding diary 555 557 3 01/15/21 20210101 NES 210101 Voiding diaries are a standard of care in the evaluation of nocturia.1-4 One parameter routinely derived from voiding diary analysis is the nocturia index (Ni), defined as nocturnal urine volume (NUV) divided by 24-h maximum voided volume (MVV; with the latter being a proxy for functional bladder capacity),5 such that Ni quantifies the degree of mismatch between nocturnal urine production and bladder storage capacity.6 The Ni is of central importance to the management of nocturia because it is the voiding diary parameter which most strongly correlates with nocturia severity (i.e., the actual number of nocturnal voids [ANV]), and improvement in this measure is characteristic of improvement in ANV, such that the Ni reflects an important target for nocturia treatment.7,8 However, in view of continued suboptimal utilization of voiding diaries in clinical practice,9,10 increasing investigative attention has been afforded to data which may be directly gleaned from nocturnal voiding diary data and a nocturnal-only workup for nocturia.11 Namely, restricting the voiding diary to only the hours of intended sleep stands to mitigate the potentially restrictive time commitment of the assessment period, as well as professional, familial, and social barriers that have been implicated as significant determinants of voiding diary nonadherence.12-15 Accordingly, we propose a modified Ni (mNi), analogous to the original Ni, but incorporating only values directly attainable from nocturnal urinary data: NUV divided by nocturnal maximum voided volume (NMVV). Fifth, the correlation between changes in mNi and ANV is significantly stronger than the correlation between changes in Ni and ANV, such that the mNi may thus be relatively favorable for monitoring treatment response. [Extracted from the article]

Introduction: Much of what is known about the etiology of nocturia (i.e., nocturnal polyuria [NP], small bladder capacity [SBC], etc.) at the population level stems from the Krimpen study, which enrolled aging males from a homogenous municipality in the Netherlands. Given the higher prevalence of benign prostatic hyperplasia and overactive bladder in black versus white males in population research, we aim to test the hypothesis that black males seeking treatment for lower urinary tract symptoms (LUTS) are more likely to have nocturia owing to SBC., Materials and Methods: We retrospectively analyzed 24 hour frequency-volume charts (FVCs) completed by males seeking treatment for LUTS at a Veterans Affairs urology clinic from 2008-2016. Patients were included if they were ≥ 18 years, identified as either Caucasian or African American, and had a complete baseline FVC showing ≥ 1 nocturnal void. Patients were stratified by race and classified as having nocturia owing to SBC (defined by a maximum voided volume < 200 mL or a nocturnal bladder capacity index > 1.3); NP (defined by a nocturnal polyuria index > 0.33); 'mixed' (SBC + NP); or 'other' (neither SBC nor NP)., Results: Between white and black patients, 28 (24%) versus 28 (26%) had NP, 32 (27%) versus 33 (30%) had SBC, and 35 (30%) versus 30 (28%) had mixed nocturia. Overall, there was no difference in distribution of underlying etiology by race (p = 0.51)., Conclusions: Our results demonstrate no difference in the etiology of nocturia between black and white males. Accordingly, race should not play a role in the evaluation of patients seeking treatment for nocturia.