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Ruud Bosch, MD, PhD Professor and chairman Department of Urology

ICI-RS 2013 Nocturia TT 4: The case for combination treatment desmopressin and drugs that decrease bladder contractility: Evidence from epidemiology and urodynamics. Ruud Bosch, MD, PhD Professor and chairman Department of Urology. The Netherlands. Evidence from epidemiology?.

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Ruud Bosch, MD, PhD Professor and chairman Department of Urology

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  1. ICI-RS 2013 Nocturia TT 4: The case for combination treatment desmopressin and drugs that decrease bladder contractility: Evidence from epidemiology and urodynamics Ruud Bosch, MD, PhD Professor and chairman Department of Urology The Netherlands

  2. Evidence from epidemiology? • What are longitudinal determinants of nocturia, as assessed by FVC’s ? • Are there any modifiable determinants? Methods [analysis from the Krimpen study] : • 1142 FVC’s at baseline • Follow up at 2, 4, 6 years with FVC’s • Generalised linear mixed effects model [GLMM] was used to examine longitudinal determinants of nocturia [>2] • GLMM accounts for: • Longitudinal character of the data • Unequal follow-up times • Missing data • Fluctuating variables [such as hypertension, cardiac symptoms]

  3. Longitudinal determinants of nocturia in older men: the Krimpen study ICI-RS 2013

  4. Longitudinal determinants of nocturia in older men: the Krimpen study

  5. Modifiable determinants of nocturia: evidence from the Krimpen study

  6. Evidence from Urodynamics? 72 women with history of OAB, but no anormalities on transurethral filling cystometry The patients underwent both filling cystometry and diuresis cystometry [furosemide] With diuresis cystometry significantly greater prevalence of DOA Interpretation: increased urine flow over UVJ triggers DOA Van Venrooij et al: J Urol 1994; 152 [5pt1]: 1535-8

  7. Modifiable determinants of nocturia: evidence from the Krimpen study

  8. Rationale for improved treatment of nocturia • Nocturnal polyuria is a significant determinant of nocturia: as NUP90, representing nocturnal urine production >90 ml/hr, as well as NUV33, representing an increased part of total 24 hr production, produced at night [ratio between night and daytime volumes] • MMV is a significant determinant of nocturia: decreased “functional [nocturnal] bladder capacity”. • There is urodynamic evidence that increased [nocturnal] diuresis triggers DOA. • The value of combination treatment should be explored !

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