A novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.

Objective: The objective of this study is to identify variables that describe nocturia-related bother in a sample of community-dwelling individuals. Materials and methods: Community-dwelling individuals age 40 years and older who woke to pass urine at night completed an online questionnaire. Participants were asked (i) their top three concerns in relation to nocturia, (ii) to agree or disagree with a list of statements related to bother, and (iii) to complete the Nocturia Impact Diary items. Fisher exact test and the Mann–Whitney U test were used to assess whether differences in nocturia-related bother existed when comparing participants stratified by nocturia severity. Results: Moderate to extreme nocturia-related bother was described by 56% of the 202 respondents and by 68% of individuals with nocturia two or more times per night. Effects of nocturia, specifically sleep disruption and impact on daytime function, were the most cited concerns. Low nocturia-related health literacy was evident. The sample was younger (83% age <70 years), predominantly female (74%) and nocturia treatment naïve (95%). Conclusion: The study highlights the potential to evaluate patient care based on change in sleep and daytime function rather than solely on nocturia frequency. A suite of patient-reported outcome measures adjunctive to clinical data may have utility in quantifying meaningful change to patients after treatment for nocturia. Level of evidence: Not applicable for this multicentre audit.

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Objective To investigate whether treatment of overactive bladder (OAB), one comorbidity of nocturia, could reduce waking to void and improve other co‐existing symptoms. Methods A prospective cohort study was conducted at Royal Melbourne Hospital. Participants received 12 weeks of standard treatment, including lifestyle interventions and pharmacotherapy. Outcome measures were nocturia episodes, severity of urinary urgency/incontinence, sleep quality, daytime somnolence, anxiety and depression scores, quality of life and change in blood pressure. Results Twenty participants completed the study. Nocturia frequency improved by one void per night. Overactive Bladder Symptom Score, sleep quality, first uninterrupted sleep time and systolic blood pressures improved. There were no significant changes in daytime somnolence, mood or quality of life. Conclusions In this pilot study, nocturia and other co‐morbid dysfunctions appeared to improve when the severity of OAB was reduced. Treatment of OAB co‐morbid with nocturia reduces urinary symptoms and may improve sleep parameters and positively impact return to health.

Objective This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs. Methods A multisite mixed methods cross‐sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher‐administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation. Results Nocturia was experienced by 260 out of 308 participants. In‐hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia. Conclusion Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.

Objective Post-menopausal nocturia is poorly understood. This study aimed to identify hormonal and lifestyle factors associated with nocturia and to understand the relative contribution of altered urine production and bladder storage dysfunction in women. Design, setting, population and methods Women ≥40 years presenting to public continence services were enrolled in a cross-sectional study. 153 participants completed a hormone status questionnaire, a validated nocturia causality screening tool and a 3-day bladder diary. Descriptive statistics and logistic regression models for nocturia severity and bladder diary parameters were computed. Results Overall, 91.5 % reported nocturia, 55% ≥2 /night. There was a difference of 167.5 mL (p<0.001) in nocturnal urine volume between women with nocturia ≥2 (median 736mL) vs less often (517mL). Significant predictors of self-reported disruptive nocturia were age (OR 1.04, 95%CI 1.002-1.073) and vitamin D supplementation (OR 2.33, 95%CI 1.11-4.91). Nocturnal polyuria was significantly more common with nocturia ≥2 compared to less often (p<0.002). 150 minutes of exercise per week was protective for nocturnal polyuria (OR 0.22, p=0.001). Nocturia index >1.3 was significantly predicted by age (OR 1.07, p<0.001), regular exercise (OR 0.41, p=0.036), day flushes (OR 4.00, p=0.013) and use of Vitamin D (OR 2.34, p=0.043). Maximum voided volumes were significantly lower with nocturia≥2 vs less often (night: 268ml vs 350mL; day: 200mL vs 290mL). Conclusions Bothersome nocturia in post-menopausal women is associated with changes to both nocturnal diuresis and bladder storage. Regular physical activity, prolapse reduction and oestrogen replacement may be adjunctive in managing bothersome nocturia in women.

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