Evaluation of nocturia in the elderly.

turia is associated with a 1.8-fold increased risk of hip fracture. Men who arise more than three times a night to urinate also have a twofold increase in mortality compared with those with fewer episodes of nocturia. Nocturia is a frequent patient complaint leading to urologic and nephrologic consultations. The causes of nocturia are many (Table 1). They can be divided into conditions affecting the storage of urine in the bladder and those involving the excessive production of urine by the kidneys. Although it is commonly assumed that the reason for nocturia is bladder dysfunction, particularly among elderly men, this assumption is not accurate. Bruskewitz et al noted that nocturia persisted in 25% of men who underwent prostate surgery for presumed bladder outlet obstruction and were monitored for three years, suggesting that the etiology of nocturia had not been addressed by surgery in these patients. A careful history and physical examination provide clues to the etiology. Symptoms such as decreased urinary stream, hesitancy, and a sense of incomplete voiding suggest bladder outlet obstruction. Frequency, urgency, and bladder spasms suggest bladder irritation, perhaps due to infection. Gross hematuria may be an indication of a bladder tumor or stones. The absence of such sympCLINICAL MEDICINE