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Volume 15 No. 04
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Accepted Papers

Scientific Investigations

Overnight Urge Perception in Nocturia Is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Population

Thomas F. Monaghan, BS1,2; Donald L. Bliwise, PhD3; Nicholas R. Suss, BS1,2; Matthew R. Epstein, BS1,2; Zhan D. Wu, BS1,2; Kyle P. Michelson, BA1,2; Christina W. Agudelo, MA1; Dennis J. Robins, MD1,2; Adrian Wagg, MBBS4; Jeffrey P. Weiss, MD1,2
1Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York; 2Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York; 3Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; 4Department of Geriatric Medicine, University of Alberta, Edmonton, Canada

Study Objectives:

The goal of this study was to compare the urge perception associated with nocturnal voiding at the time of voiding in individuals with and without depression, posttraumatic stress disorder (PTSD), or anxiety diagnoses to test the hypothesis that patients with such diagnoses are more likely to experience insomnia-driven convenience voiding during the sleep period.


A database of voiding diaries with urge perception grades (UPGs) from 429 adult males seeking treatment for nocturia at a Veterans Affairs-based urology clinic was analyzed. The UPG categorizes perception for urinating from 0 (out of convenience) to 4 (desperate urge). Diaries completed by males age 18 years and older showing ≥ 2 nocturnal voids were included. Those included (n = 178) were divided into two cohorts based on the presence (n = 62) or absence (n = 116) of one or more previously established mental health diagnoses (depression, PTSD, or anxiety). The chi-square test was used to determine significance between groups.


Patients with a mental health diagnosis were more likely to report convenience voiding compared to those without depression, PTSD, or anxiety (14.5% versus 0.8%, P < .01). However, most voids in both groups were associated with the perception of urinary urgency. There were no differences in urinary volumes or hourly rates of urine production between the groups.


A relatively small subset of urology patients experience nocturnal voiding because they are awake for reasons other than the urge to void. Mental health factors had a substantial, albeit minimal, effect. Most nocturia reflects urgency to urinate rather than voiding by convenience.


Monaghan TF, Bliwise DL, Suss NR, Epstein MR, Wu ZD, Michelson KP, Agudelo CW, Robins DJ, Wagg A, Weiss JP. Overnight urge perception in nocturia is independent of depression, PTSD, or anxiety in a male veterans administration population. J Clin Sleep Med. 2019;15(4):615–621.

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