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Purpose: We investigated the circadian rhythm of solute excretion and regulating hormones as well as blood pressure in patients with monosymptomatic nocturnal enuresis., Materials and Methods: We included 15 patients with a mean age +/- SE of 13.4 +/- 0.9 years who had monosymptomatic nocturnal enuresis with at least 3 wet nights weekly and a control group of 10 healthy children with a similar age and sex distribution. During inpatient circadian studies urine was collected during 6 periods and blood was drawn at 7 time points during 24 hours. Heart rate and blood pressure was recorded with an ambulatory blood pressure monitor every 30 to 60 minutes., Results: The total patient group excreted a significantly larger nocturnal urine volume than controls (p <0.01). Five patients had marked nocturnal polyuria (nocturnal urine volume greater than the mean in the control group +2 SD), whereas urine output in the remaining patients without polyuria were similar to controls. Nocturnal polyuria was caused mainly by increased nocturnal solute excretion, especially Na. Serum aldosterone and plasma angiotensin II showed a marked circadian rhythm in normal children with a nocturnal increase concomitant with a significant decrease in mean arterial blood pressure during sleep. In contrast, the group of patients with nocturnal polyuria showed a lack of circadian rhythm in all excretion variables as well as an attenuated rhythm in plasma angiotensin II and mean arterial blood pressure. Interestingly this group had normal circadian rhythms of the circadian rhythm markers plasma cortisol and heart rate., Conclusions: The study suggests that an abnormally large nocturnal excretion of Na caused by selectively attenuated circadian rhythms of Na regulating hormones might be an important pathogenic factor in monosymptomatic nocturnal enuresis.

Previous studies in males with lower urinary tract symptoms (LUTS) have shown that nocturia in some patients is associated with nocturnal polyuria whereas other patients have preserved circadian urine output rhythm. This outpatient study based on 7-dayss frequency/volume (FV) charts showed that patients with nocturnal polyuria and age-matched controls without nocturia had a diurnal variation in functional bladder capacity (FBC) with higher night-time values. In contrast, patients without nocturnal polyuria no diurnal variation was observed in FBC with lower day and night-time values than both controls and nocturnal polyuric patients. Nocturia volumes correlated significantly to daytime FBC in both patient groups. Voided volumes obtained from daytime pressure/flow urodynamic investigations correlated significantly with night-time FBC obtained from the FV chart. In patients with LUTS nocturia was caused by nocturnal polyuria in 10 of 23 patients and by diminished night-time functional bladder capacity in the remaining 13 patients. In conclusion, nocturia in males with LUTS referred for BPH evaluation is caused by a mismatch between nocturnal urine production and night-time FBC analogous with the pathophysiology of nocturnal enuresis. The evaluation of circadian urine production and FBC seems mandatory in the assessment of patients with nocturia and LUTS.

Objectives: To investigate if a 7-day frequency-volume (FV) chart could identify nocturia on a polyuric basis in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)., Patients and Methods: The study included 23 patients (mean age 62.8 years, range 42-78) with LUTS who were referred for the evaluation of potential BPH and 11 men (control subjects, mean age 63.3 years, range 58-69); all completed a 7-day FV chart investigation as outpatients., Results: Nocturia was associated with nocturnal polyuria in 10 of 23 patients with LUTS; these 10 patients had a diminished diurnal variation of urine production, whereas 13 patients had a diurnal variation in urine production comparable with that in controls with no nocturia. The degree of nocturia correlated positively with nocturnal urine production but showed no relationship with sleep duration. The nocturnal polyuria in these patients was associated with a higher 24-h urine production and seemed at least partly to be caused by a higher fluid intake during daytime., Conclusion: Nocturia on a polyuric basis can be detected by using a FV chart. In these patients, a 3-day FV chart would be sufficient to detect nocturia on a polyuric basis and seems therefore to be a valuable tool in evaluating patients with LUTS referred for potential BPH.

The bioavailability and pharmacokinetics of desmopressin (Minirin, DDAVP) have been studied in elderly males, aged between 55 and 75 years. In a four-way randomised study, subjects received a dose of desmopressin either intravenously (2 micrograms) or orally (200 micrograms) and either at 11 am or 10 pm. Daytime and night-time urine samples were collected both with and without desmopressin treatment. Intravenous doses of desmopressin were observed to have a longer duration of action than when the dose was given orally. These differences in efficacy may be attributable to differences in the bioavailability of desmopressin after intravenous or oral treatment.

Purpose: We investigated the circadian variation in urine output, plasma angiotensin II, aldosterone, atrial natriuretic peptide, arginine vasopressin and blood pressure., Materials and Methods: We studied 17 elderly men with nocturia and lower urinary tract symptoms, and 10 age matched controls without nocturia., Results: Of the 17 patients studied 11 had a lack of diurnal variation in urine output and increased nocturnal urine production associated with increased nocturnal sodium excretion, and 6 had a diurnal variation in urine output comparable to controls., Conclusions: Nocturia in a large proportion of elderly men with lower urinary tract symptoms is caused by nocturnal polyuria and natriuresis.

The efficacy and safety of 6 weeks of treatment with desmopressin tablets at doses of 200 to 400 micrograms.at bedtime were investigated in 33 children with monosymptomatic nocturnal enuresis. During an initial 1 to 2-week dose titration period 22 patients (67%) became either completely dry or showed improvement, 7 (21%) showed no response and 4 (12%) dropped out of therapy. During tablet treatment 17 patients on 400 micrograms.and 5 on 200 micrograms.at bedtime increased the number of weekly dry nights from 2.0 +/- 1.6 (standard deviation) during a 2-week observation period to 5.2 +/- 1.9 (p < 0.001). During a subsequent 2-week period 40 micrograms.intranasal desmopressin showed a similar overall efficacy, with a mean of 5.4 +/- 1.6 dry nights per week. In addition, intranasal treatment was able to increase the number of dry nights in 2 of the 7 nonresponders to tablet treatment.