Skip to main content

Advertisement

SpringerLink
Log in

Urinary nitrite excretion and urinary variables in patients with primary nocturnal frequency of micturition: effects of indomethacin suppositories

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Urinary nitrite excretion was measured in patients with primary nocturnal frequency of micturition (PNFM) and in normal individuals. Effects of indomethacin suppository on urine volume and other urinary variables were evaluated. The study comprised seven patients with PNFM and seven healthy control (age range 30–45 years). Nitrite was assayed in spot morning urine samples; urine volume, urine osmolality and electrolytes, serum osmolality and electrolytes and functional bladder capacity (FBC) were assayed. Both groups were then given 100 mg of indomethacin suppository daily for a maximum of 10 days and urinary variables were re-evaluated during day 10. Results showed that urinary nitrite excretion of patients with PNFM was greater than that of the normal subjects (230±62 umol/l vs. 42±30 umol/l, P<0.05). The mean (SD) 24 h urine volume and osmolality, the night urine volume and osmolality, serum osmolality, FBC, creatinine clearance, fractional excretion of sodium (FENa), fractional excretion of potassium (FEK), and urinary excretion of glucose and potassium were lower in patients with PNFM as compared with normal individuals, although not statistically significantly so, except for FBC that was significantly lower in the patients. Urinary excretion of sodium, calcium, chloride, phosphorus, magnesium, day-night urinary volume ratio, spot morning osmolality, nocturnal index, and nocturnal polyuria index were higher in patients with PNFM. Indomethacin decreased the 24 h urinary volume by 21%, creatinine clearance by 12%, osmolar clearance by 14% and urinary protein excretion by 38% in the patients. These variables decreased by 26, 45, 17 and 12% respectively in the healthy subjects, whereas 24 h urinary protein excretion increased mildly by 9%. Indomethacin increased day-night urinary volume ratio by 73% in the healthy subjects. It might be concluded that urinary nitrite excretion, urinary excretion of sodium, chloride, phosphorus, calcium, and magnesium increased and FBC decreased in patients with PNFM; Indomethacin decreased urinary volume, FENa, FEK, osmolar clearance, and free water clearance in the healthy subjects and the patients. These might explain the mechanism of action of indomethacin to reduce frequency of voiding. The possible interaction of prostaglandin and NO in the pathogenesis of PNFM is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Al-Waili N (2000) Carbamazepine to treat primary nocturnal enuresis: double - blind study. Eur J Med Res 5:40–44

    PubMed  CAS  Google Scholar 

  2. Al-Waili N (1986) Diclofenac sodium in the treatment of primary nocturnal enuresis: Double - blind cross over study. Clin Exp Pharmacol Physiol 13:139–142

    Article  PubMed  CAS  Google Scholar 

  3. Al-Waili N (2003) Elevated urinary nitrite excretion in patients with renal stones. FASEB J 17:223

    Article  PubMed  Google Scholar 

  4. Al-Waili N (2002) Increased nitrite urinary excretion in patients with primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion. Brit J Urol Inter 90:254–262

    Google Scholar 

  5. Al-Waili N (1986) Indomethaicn suppositories: an alternative treatment for nocturnal frequency of micturition. IRCS Med Sci 14:322–323

    Google Scholar 

  6. Al-Waili N (1989) Indomethacin suppository to treat primary nocturnal enuresis: Double - blind study. J Urol 142:1290–1292

    PubMed  CAS  Google Scholar 

  7. Al-Waili N (1988) Three cases of nephrotic syndrome treated by indomethacin. J Pak Med Ass 38:54–56

    CAS  Google Scholar 

  8. Andersson E, Garcia A, Persson K (1992) Electrically induced nerve - mediated relaxation of rabbit urethra involves nitric oxide. J Urol 147:253–259

    PubMed  CAS  Google Scholar 

  9. Andersson E, Ek A, Person A (1988) Effects of prostaglandin on the isolated human bladder and urethra. Acta Physiol Scand 100:165–171

    Google Scholar 

  10. Andersson E, Persson K (1995) Nitric oxide synthase and the lower urinary tract: possible implication for physiology and pathophysiology. Scand J Urol Neph 175:43–55

    CAS  Google Scholar 

  11. Asplund R, Aberg H (1996) Nocturnal micturition, sleep and well-being in women of ages 40–64 years. Maturitas 24:73–79

    Article  PubMed  CAS  Google Scholar 

  12. Bachmann S, Mundel P (1994) Nitric oxide in the kidney synthesis, localization and function. Am J Kidney Dis 24:122–129

    Google Scholar 

  13. Batislam E, Nuholu B, Peskirc O, Emir L, Uygur L (1995) A prostaglandin synthesis inhibitor, diclofenac sodium in treatment of primary nocturnal enuresis. Acta Urol Bel 63:35–38

    CAS  Google Scholar 

  14. Bennett B, Kruse N, Roppole J, Flood D, Fraser M (1995) Neural control of urethral outlet activity in vivo: role of nitric oxide. J Urol 153:2004–2009

    Article  PubMed  CAS  Google Scholar 

  15. Chen L, Salafranca N, Mehta L (1997) Cyclooxygenase inhibition decreases nitric oxide synthase activity in human platelets. Am J Physiol 273:H1854–H1859

    PubMed  CAS  Google Scholar 

  16. Dixy J, Williams D, Lightman L, Lant F, Brewerton A (1986) The effect of indomethacin on renal response to arginine vasopressin in man. Clin Sci 70:409–416

    PubMed  Google Scholar 

  17. Du Y, Li Y (1999) Inhibitory effects of indomethacin on interleukin-1 and nitric oxide production in rat microglia in vitro. Int J Immunopharmacol 21:219–225

    Article  PubMed  CAS  Google Scholar 

  18. Fraser O, Flood D, de Groat C (1995) Urethral smooth muscle relaxation is mediated by nitric oxide released from parasympathetic postganglionic neurons. J Urol 153:461A

    Article  Google Scholar 

  19. Fredrikson S (1996) Nasal spray desmopressin treatment of bladder dysfunction in patients with multiple sclerosis. Acta Neurol Scand 94:31–34

    PubMed  CAS  Google Scholar 

  20. Garcia H, Pomposiella I, Govin L (1996) Nitric oxide inhibits ADH - stimulation osmotic water permeability in cortical collecting ducts. Am J Physiol 270:F206–F210

    PubMed  CAS  Google Scholar 

  21. Garini G, Mazzi A, Buzio C, Mutti A (1996) Renal effects of captopril, indomethacin and nifedipine in nephrotic patients after an oral protein load. Nephrol Dial Transp 11:628–634

    CAS  Google Scholar 

  22. Garg C, Hassid A (1992) Inhibition of rat mesangial cell mitogenesis by nitric oxide - generating vasodilators. Am J Physiol 257:F60–F66

    Google Scholar 

  23. Gugn Y, Zhang Y, Beryer M, Fowler B, Davis L (1998) Prostaglandin E2 inhibits renal collecting duct Na+ absorption by activating the EPI receptor. J Clin Invest 102:194–201

    PubMed  Google Scholar 

  24. Hagnes G, Hand F, Dockrell E, Eadington W (1997) Physiological rate of nitric oxide in regulation of renal function in humans. Am J physiol 277:F364–F371

    Google Scholar 

  25. Hansen A, Jorgensen T (1997) A possible explanation of wet and dry nights in enuretic children. Br J Urol 80:809–811

    PubMed  CAS  Google Scholar 

  26. Haylor J, Lote J (1980) Renal function in conscious rats after indomethacin Evidence for a tubular action of endogenous prostaglandins. J Physiol 298:371–381

    PubMed  CAS  Google Scholar 

  27. Herbert L, Jacson R, Fredin D, Breyer D (1993) Evidences that separate PGE2 receptor modulate water and sodium transport in rabbit cortical collecting duct. Am J Physiol 265:F643–F652

    PubMed  Google Scholar 

  28. Hos Ren L (1993) Evidence for the role of nitric oxide in macula densa control of glomerular hemodynamics. J Clin Invest 92:1093–1098

    Article  PubMed  Google Scholar 

  29. Hrabak A, Vercruysse V, Kahan L, Vray B (2001) Indomethacin prevents the induction of inducible nitric oxide synthase in murine peritoneal macrophages and decreases their nitric oxide production. Life Sci 68:1923–1930

    Article  PubMed  CAS  Google Scholar 

  30. Hunsballe J, Rittig S, Pedersen B (1997) Single imipramine reduces nocturnal urine output in patients with nocturnal enuresis and nocturnal polyuria. J Urol 158:830–836

    Article  PubMed  CAS  Google Scholar 

  31. Kanno K, Hirata Y, Emori T, Ohta K, Eguchi S (1992) L-arginine infusion induces hypotension and diuresis/natriuresis with concomitant increased urinary excretion of nitrite/nitrate and cyclic GMP in humans. Clin Exp Pharm Physiol 19:619–625

    Article  CAS  Google Scholar 

  32. Kalla H, Chintanadilok J, Maruenda J (1999) Treatment of nocturia in the elderly. Drugs Aging 15:429–437

    Article  PubMed  Google Scholar 

  33. Kaojarern S, Chennavasin P, Anderson, Brater C (1983) Nephron site of effect of nonsteriodal anti-inflammatory drugs on solute excretion in humans. Am J Physiol 244:F134–F139

    PubMed  CAS  Google Scholar 

  34. Kawauchi A, Tanaka Y, Soh J, Ukimura O, Kojima M (2000) Causes of nocturnal frequency and reasons for its increase with age in healthy older men. J Urol 163:81–84

    Article  PubMed  CAS  Google Scholar 

  35. Kawauchi A, Tanaka Y, Soh J (2000) Causes of nocturnal urinary frequency and reasons for its increase with healthy older men. J Urol 163:81–84

    Article  PubMed  CAS  Google Scholar 

  36. Kinght M, Forman D, Al-Dabbagh A, Doll R (1987) Estimation of dietary intake of nitrate and nitrite in Great Britain. Food Chem Toxical 25:277–288

    Article  Google Scholar 

  37. Kinn C, Larsson P (1990) Desmopressin: a new principle for symptomatic treatment of urgency and incontinence inpatients with multiple sclerosis. Scand J Urol Nephrol 24:109–112

    Article  PubMed  CAS  Google Scholar 

  38. Kuo H (2002) Efficacy of desmopressin in the treatment of refractory nocturia in patients older than 65 years. Urology 59:485–489

    Article  PubMed  Google Scholar 

  39. Kuzenetsova A, Natochin V, Papaian V (1996) A physiological analysis of kidney ion - regulating function in children with enuresis. Fiza ZI me Soch 82:78–86

    Google Scholar 

  40. Line I, Li-shian Y (1997) Enhancement by nitric oxide of neurogenic contraction in the mouse urinary bladder. Naunynsch Arch Pharmacol 356:850–852

    Article  Google Scholar 

  41. Liang M, Knox G (2000) Production and function role of nitric oxide in the proximal tubule. Am J Physiol Regul Integ Comp Physiol 278:R1117–R1124

    CAS  Google Scholar 

  42. Low A, Armstrong B, Mauger M (1989) The unstable urethra in female. Obstet. Gynecol 74:69–72

    PubMed  CAS  Google Scholar 

  43. Low A (1977) Urethral behavior during the involuntary detrusor contraction. Am J Obstet Gynecol 128:32–37

    PubMed  CAS  Google Scholar 

  44. Maggi A (1992) Prostanoid as local modulator of reflex micturition. Pharmacol Res 25:13–20

    Article  PubMed  CAS  Google Scholar 

  45. Matthiesen T, Rittig S, Norgaard J, Pedersen E (1996) Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms. J Urol 156:1292–1299

    Article  PubMed  CAS  Google Scholar 

  46. Marnett L, Wright T, Crews B, Tannenbaum S, Marrow J (2000) Regulation of prostaglandin biosynthesis by nitric oxide is revealed by targeted detection of inducible nitric oxide synthase. J Biol Chem 275:13427–13430

    Article  PubMed  CAS  Google Scholar 

  47. McKeigue M, Reynard M (2000) Relation of nocturnal polyuria of the elderly to essential hypertension. Lancet 355:486–488

    PubMed  CAS  Google Scholar 

  48. Medel R, Dieguez S, Brindo M, Ayuso S, Canepa C (1998) Monosymptomatic primary enuresis: difference between patients responding or not responding to oral desmopressin. Br J Urol 81:46–49

    PubMed  Google Scholar 

  49. Mizutani T, Akinaga N, Takatera H (1989) Urinary nitrite in Japanese patients with urinary tract infections. Sci Total Environ 80:161–165

    Article  PubMed  CAS  Google Scholar 

  50. Morcose E, Wiklund P (2001) Nitrite and nitrate measurement in human urine by capillary electrophoresis. Electrophoresis 22:2763–2768

    Article  PubMed  Google Scholar 

  51. Motta A, Franchi A, Gimeno M (1997) Role of nitric oxide on uterine and ovarian prostaglandin synthesis during luteolysis in rat. Prost Leuk Essential Fat Acid 56:265–369

    Article  CAS  Google Scholar 

  52. Murphy J, Badia P, Myers L, Boecker R, Wright P (1994) Nonsteriodal anti-inflammatory drugs affect normal sleep patterns in humans. Physiol Behav 55:1063–1066

    Article  PubMed  CAS  Google Scholar 

  53. Neveus T, Tuvemo T, Lackgren G, Sterberg A (2001) Bladder capacity and renal concentrating ability in enuresis: pathogenic implication. J Urol 165:2022–2025

    Article  PubMed  CAS  Google Scholar 

  54. Noonan T, Banks O (1999) The role of nitric oxide in saline - induced natriuresis in rats. Proc Soc Exp Biol Med 221:376 – 381

    Article  PubMed  CAS  Google Scholar 

  55. Ozawa H, Chancellor B, Jung Y, Yokoyama T, Fraser O (1999) Effect of intravesical nitric oxide therapy on cyclophosphamide-induced cystitis. J Urol 162:2211–2216

    Article  PubMed  CAS  Google Scholar 

  56. Palea S, Toson G, Pieta C, Trist G, Artibani N, Romano O (1998) Pharmacological characterization of thromboxane and prostanoid receptors in human isolated urinary bladder. Br J Pharmacol 124:865–872

    Article  PubMed  CAS  Google Scholar 

  57. Parlani M, Conte B, Mazini S (1993) Nonadrenergic, noncholinergic inhibitory control of the rat external urethral sphincter: involvement of nitric oxide. J Pharmacol Exp Ther 265:713–718

    PubMed  CAS  Google Scholar 

  58. Ray C, Carney L, Gillies H (1985) Effect of indomethacin on urine concentration and dilution in the rat. Clin Sci 69:293–298

    PubMed  CAS  Google Scholar 

  59. Salazar J, Liinas T, Gonzalez D, Quesada T, Pinilla M (1995) Role of prostaglandins and nitric oxide in mediating renal response to volume expansion. Am J Physiol 268:R1442–R1448

    PubMed  CAS  Google Scholar 

  60. Sener F, Hasanoglu E, Soylemezolgu O (1998) Desmopressin versus indomethacin treatment in primary nocturnal enuresis and the role of prostaglandin. Urology 52:878–881

    Article  PubMed  CAS  Google Scholar 

  61. Seyberth W (1987) The significance of renal prostaglandins for kidney function in early childhood. Monatsschr Kinderjeilkd 135:178–184

    CAS  Google Scholar 

  62. Sorenson S, Norgard P, Djurhuus C (1986) Continues urethral pressure measurement in healthy female volunteers. Neurourol Urodyn 5:525–529

    Article  Google Scholar 

  63. Suk Young J, Matthew F, Hideo O (1999). Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol 162:204–212

    Article  PubMed  Google Scholar 

  64. Tanahashi M, Sekizawa T, Yoshida M (1999) Effects of sodium nitroprusside on renal function and NO-cGMP production in anesthetized dogs. J Cardiovasc Pharmacol 33:401–408

    Article  PubMed  CAS  Google Scholar 

  65. Vizzard A, Erdman L, Forstermann U, de Groat C (1994) Differential distribution of nitric oxide synthase in neural pathways to the urogenital organs (urethra, penis, urinary bladder) of the rat. Brain Res 646:279–288

    Article  PubMed  CAS  Google Scholar 

  66. Walker P, Moore R, Cheung Y, Brace A (1992) Indomethacin-induced urinary flow rate reduction in the ovine fetus is associated with reduced free water clearance and elevated plasma arginine vasopressin levels. Am J Obstet Gynecol 167:1723–1731

    PubMed  CAS  Google Scholar 

  67. Wall L (1990) The management of detrusor instability . Clin Obstet Gynecol, 33:367–377

    Article  CAS  Google Scholar 

  68. Weiss P, Blaivas G (2000) Nocturia. J Urol 163:5–12

    Article  PubMed  CAS  Google Scholar 

  69. Weiss P, Stember D, Chakin C, Blaivas G (1999) Evaluation of the etiology of nocturia in men The nocturia and nocturnal bladder capacity indices. Neurourol Urodyn 18:559–565

    Article  PubMed  CAS  Google Scholar 

  70. Weiss P, Stember D, Blaivas J (1998) Nocturial in adult: etiology and classification. Neurol Urody 17:467–472

    Article  CAS  Google Scholar 

  71. Wheeler A, Pontari M, Dokita S (1997) Age dependent changes in particulate and soluble guanylyl cyclase activities in urinary tract smooth muscle. Mol Cell Bioch 169:115–120

    Article  CAS  Google Scholar 

Download references

Acknowledgment

Haj Saeed Lootah, Chairman of Islamic Establishment for Education, Dubai, kindly supported our work. Dr. Nader Santo, Dr. M. Akmal and Mr. Amjeed Ali, Department of Medical laboratories, Dubai Specialized Medical Center, Dubai, provided assistant.

Author information

Authors and Affiliations

  1. Al-Waili`s Foundation for Science and Trading, New York, USA

    Noori S. Al-Waili, Thia N. AL-Waili, Ali N. AL-Waili & Khelod Y. Saloom

  2. Department of Nephrology/Urology, Dubai Specialized Medical Center and Medical Research Labs, Islamic Establishment for Education, Dubai, United Arab Emirates

    Noori S. Al-Waili

  3. Life Support Technologies Groups INC, The Mount Vernon Hospital, 7th Avenue, 12 North, New York, 10550, USA

    Noori S. Al-Waili

Authors
  1. Noori S. Al-Waili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thia N. AL-Waili
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali N. AL-Waili
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Khelod Y. Saloom
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Noori S. Al-Waili.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Waili, N.S., AL-Waili, T.N., AL-Waili, A.N. et al. Urinary nitrite excretion and urinary variables in patients with primary nocturnal frequency of micturition: effects of indomethacin suppositories. World J Urol 23, 287–294 (2005). https://doi.org/10.1007/s00345-005-0011-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-005-0011-9

Key words

Search

Navigation