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Nocturia , Polyuria , Noctu-polyuria ?

Nocturia , Polyuria , Noctu-polyuria ?. Dr Manuel BW Q UE 郭 文 偉 醫 生 泌尿外科專科醫生. 夜尿 影響 睡眠質素. 活動能力減弱， 影響日間工作. Productivity, vitality and utility . 資料來源

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Nocturia , Polyuria , Noctu-polyuria ?

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  1. Nocturia,Polyuria, Noctu-polyuria? Dr Manuel BW QUE 郭 文 偉 醫 生 泌尿外科專科醫生

  2. 夜尿影響睡眠質素 • 活動能力減弱，影響日間工作 Productivity, vitality and utility 資料來源 Kobelt, G.; Borgstrom, F.; Mattiasson, A. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia.. BJU International 91, 190-195, 2003

  3. 夜尿影響睡眠質素 • 活動能力減弱，影響日間工作 • 沒有良好的睡眠，會影響患者健康。 • 據統計，女性比男性更容易受夜尿問題所影響， • 增加請病假機會。 資料來源 Asplund, R. and Aberg, H. Nocturnal micturition, sleep and well-being in women of ages 40-64 years. Maturitas 24, 73-81, 1996

  4. 4 夜尿引起併發症

  5. 夜尿引起併發症 • 對老年人而言，在半睡半醒時上廁所， • 容 易跌倒,或甚至導至骨折。 資料來源: Apple Daily June 2005

  6. 夜尿影響生活質素 廁奴! 情緒低落

  7. 夜尿普遍嗎? • 根據香港泌尿外科學會2003年的調查結果顯示 • 超過47%的香港人患有夜尿症 • 人數高於其他亞洲國家。 資料來源 Tam, P. C., Asian Nocturia Forum 2005

  8. 夜尿普遍嗎? • 與其他亞洲地區比較， • 「夜尿症」在港的發病率偏高， • 約佔200萬人。 • 在美國，大概有49%人口受夜尿問題影響 • (年齡 >18; N=7,070) 資料來源 Asian Nocturia Forum 2005 ; ICS 2000, Tampere; David M Bednar

  9. 夜尿普遍嗎? 男女性的發病率相約, 均是47%左右 。 女性 男性 資料來源 Tam, P. C., Asian Nocturia Forum 2005

  10. Results : Presentation In 994 men aged 40 to 88, Nocturia was the most common symptom for consultation. 12% had a prior episode of acute urinary retention (AUR) About 90% had moderate-to-severe lower urinary tract symptoms (LUTS), and the severity increased with age. 82% reported sexual dysfunction, and it correlated with the severity of LUTS. the most common co-morbidities were hypertension (38%) and obesity (36%). AMORE: An Asian Multi-National Prospective Observational Registry of Patients With Benign Prostatic Hyperplasia OAB

  11. 「什麼（才算）是夜尿? 」 Dr Manuel BW QUE 郭 文 偉 醫 生 泌尿外科專科醫生

  12. 什麼是夜尿? 根據 國際理遺學會 (International Continence Society) 的定義， 在夜晚睡眠時因有尿意而需要起床如廁， 一次或以上，即屬「夜尿」。 需要從睡眠中醒來 • 資料來源 • Van Kerrebroeck, P. et al. The standardization of terminology in nocturia. Neuro-urology and Urodynamics 21, 179-183, 2002 • 2. Jackson, S. Lower urinary tract symptoms and nocturia in men and women: prevalence, aetiology and diagnosis. BJU International 84 Supp1. 5-8, 1999

  13. 2005/6 下尿路病徵的統計 有七成(71%)的被訪者表示曾下尿路徵狀

  14. 2003香港泌尿外科學會調查結果 OAB

  15. Nocturia Management Simple arithmetic analysis of 24 hour voiding diary

  16. 尿液量杯和 小便日記 小便日記記錄 (Voiding Diary) • 在這記錄表上記錄每日小便時間、小便次數和每次小便尿量。 • 隨意訂出三整天來完成這記錄，這三天毋須是連續的。 • 你可選較方便的日子來進行記錄，例如是週未或假期。 • 每次小便均以「尿液量杯」儲起，量度並記錄後倒掉。 www.night-toilet.com.hk 網站內的醫生可提供尿液量杯

  17. 00:00 09:00 250 10:15 200 150 200 150 12:30 150 350 180 350 11:00 330 02:30 13:00 350 05:30 14:45 250 180 510 600 120 720 14:00 17:50 350 20:00 650 07:30 860 350 1070 22:30 350 小便日記記錄 (Voiding Diary) 1950 1070 860

  18. Nocturia夜尿的成因

  19. 夜尿的成因 膀胱容量 太少 夜間小便 太多 成年人的膀胱容量大約 400-500ml

  20. Nocturia

  21. Nocturia: Bladder Capacity

  22. Nocturia: Polyuria

  23. Sleep Disordered Breathing (SDB) • Sleep Apnea : Sudden cessation of breathing due to airway obstruction during sleep • Older adults with severe sleep apnea have greater number of nocturia episodes •  airway resistance  hypoxia  pulmonary vasoconstriction  right atrial pressure  increased ANP  increased Na & water excretion

  24. Nocturia: Polyuria

  25. Nocturnal Polyuria • NUV > 6.4 ml/kg • Nocturnal diuresis >= 0.9ml/min • NUV/24 hr urine >= 0.35 • 1st am voided urine INCLUDED in NUV • 1st am void NOT included in nocturnal voids Matthiesen, TB et al:JUrol 156: 1292,1996

  26. 抗利尿荷爾蒙(Antidiuretic Hormone, ADH) ADH ADH

  27. 「夜間多尿症」？ • 醫學研究顯示，有超過七成的夜尿問題是由夜間多尿症引起的。 • 如果夜間小便量超過每日總尿量的1/3，即約 500-600ml ，便屬「夜間多尿症」。 資料來源 Lose G. et al. Clinical Experiences with desmopressin for long-term treatment of nocturia. Journal of Urology 172, 1021-1025, 2004

  28. 夜尿的成因 膀胱容量 太少 夜間小便 太多 成年人的膀胱容量大約 400-500ml

  29. 夜尿的成因 High Urine Output (night) Low Bladder Capacity • Caffeine/alcohol • Night drinks • Fluid retention • Cardiac • DM/Renal/Hepatic • Loss of ADH rthym • Sleep Apnea • BPH • OAB • Bladder Path • Behavioural • Anxiety/ Stress/ • Sleep

  30. Nocturia Management Dr Manuel BW QUE 郭 文 偉 醫 生 泌尿外科專科醫生

  31. Nocturia

  32. Nocturia: Bladder Capacity

  33. 良性前列腺增生（徵狀） 下尿路症狀 (LUTS) 刺激性症狀 梗阻性症狀 / 排尿困難

  34. 國際前列腺 徵狀評分表 IPSS 輕度症狀 ---0 至 7 分 中度症狀 ---8 至 19 分 嚴重症狀 ---20至 35 分 評分結果 郭文偉 醫生

  35. Flow Rate & Bladder Scan 殘餘小便 尿流速率

  36. 尿流速率檢查 Flow Rate Study 尿流速率

  37. Flexible cystoscopy軟式光纖膀胱內視鏡

  38. 膀胱過度活躍症 尿急 突如其來 難以忍耐 sudden desire to pass urine which is difficult to defer 1 = usually not able to hold 2 = hold till toilet if go immediately 3 = hold till finish task

  39. Low Bladder Capacity • Antispasmodics • Anticholinergics • Propantheline, hyoscyamine • Oxybutynin • Antimuscurinics • Solifenacin

  40. Solifenacin & Nocturia 43% of patients reported no urgency. 42% of patients returned normalised voiding frequency (<8 voids/day). Reference: Haab f, Cardozo L, Chapple C, Ridder AM for the Solifenacin Study Group. EurUrol 2005: 47(3): 376-384. OAB

  41. 藥物療法 口乾 便秘 眼澀 OAB

  42. TamsulosinOcas®improves Nocturia control by 57% placebo tamsulosin Ocas® 0.4 mg N=117. *P=0.028. IPSS=International Prostate Symptom Score. Adapted from Djavan B, et al. Eur Urol Suppl 2005;4:61-68. OAB

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