Once Nocturia, Always Nocturia? Natural History of Nocturia in Older Men Based on Frequency-Volume Charts: The Krimpen Study

PURPOSE: Nocturia is a highly prevalent and bothersome symptom that might (spontaneously) resolve. However, longitudinal data are not available on the incidence and resolution of nocturia assessed with frequency-volume charts. In this study we determined the prevalence, incidence and resolution rates of nocturia assessed by frequency-volume charts, and compared nocturnal voiding frequency over time as assessed by frequency-volume charts and questionnaires. MATERIALS AND METHODS: A longitudinal, population based study was conducted among 1,688 men 50 to 78 years old with followup rounds at 2.1, 4.2 and 6.5 years. Nocturnal voiding frequency was determined with frequency-volume charts and, for comparison purposes, with a question from the International Prostate Symptom Score. Nocturia was defined as nocturnal voiding frequency 2 or greater. Prevalence, incidence and resolution rates were also determined. RESULTS: At the 2.1-year followup the incidence rate was 23.9% and the resolution rate was 36.7%. The incidence rate was highest in the oldest group (70 to 78 years) and lowest in the youngest (50 to 54 years), whereas the resolution rate was highest in the group 55 to 59 years old and lowest in the oldest group. Because of the high resolution rate, no reliable incidence rates can be calculated. Despite fluctuation, the prevalence of nocturia increased with age and over time (from 34.4% to 44.7% for the total group, p <0.05). Men who had a frequency-volume chart-nocturnal voiding frequency less than International Prostate Symptom Score-nocturnal voiding frequency (6% of the population) more often had this later on. CONCLUSIONS: In this population frequency-volume chart assessed nocturia shows considerable fluctuation. Nevertheless, prevalence increases over time and with increasing age. Men who once had frequency-volume chart-nocturnal voiding frequency less than International Prostate Symptom Score-nocturnal voiding frequency are more likely to have this again. Therefore, frequency-volume charts as well as the International Prostate Symptom Score should be used when evaluating nocturia.