Objective: To characterise the prevalence of nocturnal polyuria in a cohort of people with Parkinson’s disease (PD) with lower urinary tract symptoms.

Background: Lower urinary tract symptoms (LUTS) are common in PD affecting half of all patients. Nocturia is most frequently reported and impacts on the quality of sleep with subsequent daytime fatigue. It also necessitates patients to move when their medication is least optimised. The causes of nocturia can be multifactorial, such as an overactive bladder (OAB) associated with PD as well as other co-morbidities such as prostatic hypertrophy. Nocturnal polyuria (NP) is another cause of nocturia, however its association with PD has not been well documented. NP is not a specific disorder of the lower urinary tract and is rather caused by over-production of urine by the kidneys. Finding NP is important, as this will not respond to standard treatments for OAB and may prevent administration of unwarranted medications with side-effects.

Method: Consecutive participants enrolled into the STRIPE clinical trial of tibial nerve stimulation were asked to complete 72-hour bladder diaries as part of their baseline assessment. STRIPE has broad inclusion criteria of symptoms of overactive bladder and idiopathic PD, with recruitment undertaken from throughout the South-West of England. Bladder diaries required participants to measure voided volume day and night as well as daily fluid intake.

Results: To date, 38 consecutive patients recruited to STRIPE or undergoing eligibility procedures completed 72-hour bladder diaries for symptoms including nocturia, urgency or a combination of both. The mean nocturnal polyuria index (NPi) for the cohort was 35.4 (CI 31.7-39.2) and nocturnal urine production ml/hr  was 80.5 (CI 66.6-94.3). 21 (55.2%) patients reached the threshold definition for NP based on NPi and 16 (42.1%) for NUP90 (nocturnal urine production >90ml/hr) criteria. Correlation with the International Consultation on Incontinence Questionnaire-LUTS score was undertaken where performed.

Conclusion: NP was present in a large proportion of PD patients with lower urinary tract symptoms, as per multiple threshold definitions. This suggests that NP may be an important contributor to nocturia in PD. The presence of NP should be sought with the use of a 72-hour bladder diary and has important implications for suggesting appropriate treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nocturnal-polyuria-in-parkinsons-disease/