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Nocturia and sleep quality after transurethral resection of the prostate
N. Wada, A. Numata, K. Hou, M. Watanabe, M. Kita, S. Matsumoto, H. Osanai, M. Fujisawa, and H. Kakizaki
International Journal of Urology, Volume 21, Issue 1, January 2014, Pages 81-85
Commented by Prof. Antonella Giannantoni:
Lower urinary tract symptoms due to Benign Prostatic Obstruction (BPO) are one of the main urological conditions causing nocturia in males. In the present article, Wada and co-workers investigate the effects of transurethral resection of the prostate (TURP) on sleep quality and nocturia. The authors conducted a prospective multicenter study in Japan. 49 patients with a nocturia score (question 7 of the IPSS questionnaire) of 2 or more, with urinary symptoms caused by BPO, were included in the study. Patients underwent uroflowmetry and were invited to answer the IPSS questionnaire as well as the Pittsburgh Sleep Quality Index (PSQI) before and 6 months after TURP. The primary outcome of the study was to assess whether the intervention improved sleep quality in these patients; correlations between sleep quality and nocturia were also investigated.
As a result, the authors found that TURP was able to significantly improve some components of the PSQI questionnaire, such as subjective sleep quality and habitual sleep efficiency, in those patients who already had a sleep disorder before the operation. Nocturia was significantly related to the patient’s age and item 4 of the PSQI questionnaire (habitual sleep efficiency), but the nocturia score did not correlate with the PSQI total score or other components. With regard to the improvement of nocturia after TURP, the nocturia score of the IPSS questionnaire was reduced by an average of 1.1 points; it showed the least improvement among the seven sub-scores of the IPSS questionnaire. The authors observe that the persistence of sleep disorders in these patients was associated with persistent voiding and storage symptoms.
The results of the present article are impressive, as they indicate that the nocturia score is least specific to symptoms associated with BPO or least sensitive to the therapeutic effect on symptoms. In addition, these results demonstrate the complexity of the symptom “nocturia” and that many underlying conditions may be responsible for the relationship between sleep disorders and nocturia in males affected by BPO.
To evaluate the clinical efficacy of transurethral resection of the prostate on nocturia and sleep disorders in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction.
A prospective multicenter study including lower urinary tract symptoms suggestive of benign prostatic obstruction patients with nocturia (twice or more) undergoing transurethralresection of the prostate was carried out. All patients were assessed using the International Prostate Symptom Score and the Pittsburgh Sleep Quality Index at baseline, and 6months after transurethralresection of the prostate.
Overall, 49 patients were included in the study. A total of 20 of them (41%) had a sleep disorder defined as a score of 5.5 or more on the Pittsburgh Sleep Quality Index global score. The nocturia score significantly correlated with component4 of the Pittsburgh Sleep Quality Index (habitual sleep efficiency). Nocturia significantly decreased after transurethral resection of the prostate from 3.0±1.2 to 1.9±0.8, whereas the global Pittsburgh Sleep Quality Index score did not. In 20 patients with a sleep disorder before transurethral resection of the prostate, subjective sleepquality (component1) and habitual sleep efficiency (component4) significantly decreased after transurethral resection of the prostate, but this was not the case for the global Pittsburgh Sleep QualityIndex score. In 16 patients with a persistent sleep disorder after transurethral resection of the prostate, International Prostate Symptom Score, voiding and storage symptoms score were higher than those of patients without a sleep disorder, although the nocturia score improved equivalently in both groups.
Transurethral resection of the prostate diminishes nocturnal urinary frequency and partly improves sleep quality in patients with nocturia and lower urinary tract symptoms suggestive of benign prostatic obstruction. A persistent sleep disorder after transurethral resection of theprostate is associated with persistent voiding and storage symptoms.