Urology Department, Ghent University Hospital, Ghent, Belgium.
Neuro-Urology Unit, PMR Department, Université de Versailles Saint Quentin, APHP, Raymond Poincaré Hospital, Garches, France.
Eur Urol Focus. 2020 Sep 15;6(5):922-934. doi: 10.1016/j.euf.2020.02.007. Epub 2020 Mar 17.
Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population.
To systematically review the literature about nocturia in neurological patients.
Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators.
A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not.
Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients.
In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.
夜尿症是最常见和最恼人的下尿路症状（LUTS）之一，但在神经人群中如何识别和管理这种症状尚无明确共识。
系统综述有关神经科患者夜尿症的文献。
通过 Cochrane 和 Medline 数据库的电子搜索确定研究。如果参与者患有多发性硬化症（MS）、帕金森病（PD）、中风、脊髓损伤（SCI）等多种神经病理学，并报告了夜尿症的流行病学、病因、诊断或治疗数据，则将这些研究纳入。两位作者使用预先确定的数据集（包括研究质量指标）独立提取文章。
共纳入 132 项研究；其中 46 项评估了夜尿症的流行病学，28 项评估了可能的病因，10 项评估了诊断工具，60 项评估了治疗方法。夜尿症的患病率因病理学和使用的定义而异，范围从 15%到 96%不等。它是 PD 和中风患者最常报告的 LUTS 之一。发现了一些经过验证的问卷可用于筛查该人群的夜尿症。病因众多：LUT、肾脏、睡眠、心血管功能障碍等。治疗针对这些机制，总体偏倚风险评估为高或严重。MS 患者的证据水平最高：盆底肌训练、大麻素和去氨加压素有效，但褪黑素无效。在中风患者中，经皮骶神经和经皮胫神经刺激（TTNS）改善了夜尿症；在 PD 患者中，TTNS、索利那新和罗替高汀无效。
夜尿症在神经障碍患者中非常普遍。病因和治疗方法与普通人群相同，但在神经科患者中研究甚少。
在本报告中，我们研究了有关神经疾病患者夜尿症（即睡眠期间醒来排尿的事实）的已发表研究。我们发现，该人群中夜尿症非常普遍，病因与普通人群相同，但可能合并存在，治疗方法也相同，但总体证据水平较弱。我们的结论是，需要对此主题进行更多研究。
