International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function

Abstract

Introduction The terminology for nocturia and nocturnal lower urinary tract function is reviewed and updated in a clinically and practically‐based consensus report. Methods This report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardisation Steering Committee (SSC). All relevant definitions were updated on the basis of research over the last 16 years since the publication of the first nocturia standardization document in 2002. An extensive process of 16 rounds of internal and external reviews was involved to examine each definition exhaustively, with decision‐making by collective opinion (consensus). Results A clinically‐based terminology report for nocturia and nocturnal lower urinary tract function, encompassing five key definitions divided into signs and symptoms has been developed. Clarity and user‐friendliness have been key aims to make it interpretable by healthcare professionals and allied healthcare practitioners involved in the care of individuals with nocturnal lower urinary tract function. Conclusion A consensus‐based terminology report for nocturia and nocturnal lower urinary tract function has been produced to aid clinical practice and research.

International Continence Society consensus on the diagnosis and treatment of nocturia

“…Following the meeting, a nonsystematic keyword-based literature search was performed using Google (search on "guidelines 2010-2017" + symptom/sign/disease terms [edema, hypertension, heart failure, diet, menopause, male LUTS, OAB, prolapse, renal failure, diabetes insipidus, and diabetes mellitus]). All expert panel members were also invited to add any additional important guidelines from the different *The nocturia definition was recently updated by the International Continence Society (see the article by Hashim et al 4 ) as: The number of times urine is passed during the main sleep period. Having woken to pass urine for the first time, each urination must be followed by sleep or the intention to sleep.…”

“…History-taking with or without the use of validated questionnaires is structured based on symptoms of the filling phase and the emptying phase of the bladder. 4,12 Physical examination focusses mainly on assessment of the prostate, vaginal examination for pelvic organ prolapse, and any urethral pathology, according to the relevant guidelines.…”

“…A residual urine measurement is, therefore, part of the initial assessment of nocturia. 4 When reduced voided volumes are seen, imaging, urodynamics, and occasionally cystoscopy are performed, as appropriate.…”

“…There is level 1a evidence that desmopressin and CPAP treat nocturia. 4,7 A summary of the prescribing information for available desmopressin formulations for nocturia from the United States, Australia, and Europe is given in Table 2. The panel agreed that bothersome nocturia should be treated (17/19); however, there was no consensus regarding what level of severity warrants treatment (≥2 voids/night [5/19], or any nocturia [12/19]).…”

Time of peak nocturnal diuresis rate between men with secondary nocturnal polyuria versus nocturnal polyuria syndrome

“…Nocturia-defined as the number of times urine is passed during the main sleep period, wherein each urination is followed by sleep or the intention to sleep-is among the most prevalent and bothersome lower urinary tract symptoms (LUTS). 1,2 Nocturnal polyuria (NP), which is characterized by the production of an abnormally large volume of urine during sleep, is thought to be the most common cause of nocturia overall, particularly in the elderly. 3 Excessive nocturnal urine volume is a cardinal feature of many systemic disease states, including obstructive sleep apnea (OSA), congestive heart failure (CHF), chronic kidney disease (CKD), diabetes insipidus (DI), and peripheral edema, as well as medications (eg, loop diuretics), and lifestyle factors (eg, excessive evening fluid intake).…”