A practical approach to the management of nocturia

Abstract

SummaryAimTo raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.MethodsA multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.ResultsNocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%‐18% of those aged 20‐40 years, rising to 28%‐62% for those aged 70‐80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia‐related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency‐volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low‐dose, gender‐specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid‐late afternoon, dependent on the specific serum half‐life. Patients not responding to these basic treatments should be referred for specialist management.ConclusionsThe cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.

International Continence Society consensus on the diagnosis and treatment of nocturia

“…The maximum voided volume, void frequency, and the ratio of nocturnal to 24‐hour urine production are the most used diary parameters to study and assess nocturia . A maximum voided volume of 350 mL is generally considered as reduced without real evidence to support this criterion.…”

“…Other factors that will influence the impact of concomitant medication are the timing of administration, mode of administration, formulation (long‐ vs short‐acting), and so on. Most of these factors have not been well studied …”

Impact of nocturia on patients' health‐related quality of life and healthcare resource utilisation compared with OAB and BPH: Results from an observational survey in European and American patients

“…Literature has pointed to a delay in the proper diagnosis, or even misdiagnosis and poor management of the nocturia condition . Kobelt's study confirms that nocturia significantly reduces the general quality of life and work productivity for those who conduct active professional activities.…”

“…Nocturia is a common yet under‐reported lower urinary tract symptoms (LUTS) condition . Recognised by the International Continence Society (ICS) as a standalone condition in 1999, nocturia is defined as the condition when an individual has to wake at night to void one or more times, with each of the voids followed by sleep .…”

“…Nocturia is often associated with or caused by nocturnal polyuria (NP), the excessive production of renal urine during the night . Current treatments for the more widely diagnosed overactive bladder (OAB) and benign prostatic hyperplasia (BPH) aim to increase bladder capacity and/or lower bladder outlet obstruction, but these do not always effectively treat those patients suffering from nocturia . Nevertheless, nocturia is increasingly recognised as one of the most bothersome symptoms for those suffering from LUTS, and the leading cause of sleep disturbance .…”