Miller M
Department of Medicine, School of Medicine, Sinai Hospital of Baltimore and the Johns Hopkins University School of Medicine, Maryland, USA.
J Am Geriatr Soc. 2000 Oct;48(10):1321-9. doi: 10.1111/j.1532-5415.2000.tb02608.x.
To review the physiological changes of aging which affect the systems involved in urine formation and to consider how these changes interact with changes in bladder function, thereby leading to the onset of nocturnal polyuria with associated urinary frequency, nocturia, and incontinence. Based on this information, data are presented on the effectiveness of pharmacological interventions which reduce the rate of urine formation and, thus, can be of benefit in reducing symptoms, especially during the nighttime.
Peer-reviewed journal articles were identified by MEDLINE Search and by review of the literature.
As a consequence of age-associated diminished renal concentrating capacity, diminished sodium conserving ability, loss of the circadian rhythm of antidiuretic hormone secretion, decreased secretion of renin-angiotensin-aldosterone, and increased secretion of atrial natriuretic hormone, there is an age-related alteration in the circadian rhythm of water excretion leading to increased nighttime urine production in older people. The interaction of nocturnal polyuria with age-related diminution in functional bladder volume and detrusor instability results in the symptoms of urinary frequency, nocturia and, in some persons, incontinence. The additional impact of Alzheimer's disease on these physiological and aging changes, as well as on a diminished perception of bladder fullness, leads to an even greater risk of urinary incontinence in these patients. Treatment of nocturnal polyuria with the antidiuretic hormone analog, DDAVP (desmopressin), can result in decreased nocturnal urine production with improvement in symptoms of frequency, nocturia, and incontinence.
回顾影响尿液生成相关系统的衰老生理变化，并探讨这些变化如何与膀胱功能变化相互作用，从而导致夜间多尿及相关尿频、夜尿症和尿失禁的发生。基于这些信息，本文介绍了降低尿液生成速率的药物干预措施的有效性，因此这些措施有助于减轻症状，尤其是在夜间。
通过医学文献数据库检索和文献综述确定同行评议的期刊文章。
由于与年龄相关的肾浓缩能力下降、钠保存能力减弱、抗利尿激素分泌昼夜节律丧失、肾素 - 血管紧张素 - 醛固酮分泌减少以及心房利钠肽分泌增加，老年人水排泄的昼夜节律出现与年龄相关的改变，导致夜间尿量增加。夜间多尿与年龄相关的功能性膀胱容量减小和逼尿肌不稳定相互作用，导致尿频、夜尿症症状，在某些人还会导致尿失禁。阿尔茨海默病对这些生理和衰老变化以及膀胱充盈感减弱的额外影响，导致这些患者尿失禁的风险更高。使用抗利尿激素类似物去氨加压素（DDAVP）治疗夜间多尿，可减少夜间尿量，改善尿频、夜尿症和尿失禁症状。
