Nocturia: an overview of evaluation and treatment

Abstract

OBJECTIVE: Nocturia is a highly prevalent and bothersome condition. It is associated with multiple medical comorbidities and an increased mortality. Recent investigations have improved understanding of nocturia and its evaluation and treatment. This paper aims to review the classification, etiology, associated medical conditions, evaluation, and treatment of nocturia. MATERIALS AND METHODS:A review was conducted surveying published clinical trials, meta-analyses and current clinical practice guidelines on nocturia available as of July 2014. Epidemiology, presentation, evaluation, and treatment recommendations are presented. RESULTS:Nocturia is a multifactorial condition. Evaluation should include thorough medical history documenting fluid intake, quantified and timed urine output, as well as signs and symptoms of other comorbid conditions. Thorough physical Exam should focus upon detection of conditions contributing to nocturia. Treatment should consist of optimization of underlying medical conditions, behavioral modifications, followed by medications if conservative management fails. Antimuscarinics and alpha blockers have not demonstrated to be effective. Recent studies indicate a possible role of desmopressin in the treatment of nocturia, but concerns about hyponatremia in older patients remain. CONCLUSIONS:Nocturia is a bothersome condition. Treatment of associated co-morbidities is central to treatment. Currently available treatments are available, but efficacy is limited.

A practical approach to the management of nocturia

“…A thorough assessment of nocturia and its possible causes is crucial before treatment initiation (Table ; also see Checklist available as online material) . The evaluation of a patient should begin with taking a thorough history to assess, understand and discriminate LUTS in general and nocturia in particular.…”

“…The use of antimuscarinics or β 3 ‐agonists (mirabegron) for overactive bladder management and α 1 ‐blockers, 5α‐reductase inhibitors with or without α 1 ‐blockers, PDE5i or plant extracts for male LUTS/bladder outlet obstruction has been shown to significantly reduce nocturnal voiding frequency in populations where the indicated condition is shown to be present, albeit to limited clinical effects of approximately −0.2 episodes per night on average compared to placebo . Emerging evidence has also indicated a role for onabotulinumtoxinA injections in reducing night‐time nocturia in patients with overactive bladder without nocturnal polyuria …”