Nocturia is often inadequately assessed, diagnosed and treated by physicians: results of an observational, real‐life practice database containing 8659 European and US ‐American patients

Abstract

SummaryAimsThe aim of this study was to investigate the quality and timing of the diagnosis and treatment of nocturia in real‐life practice in European and US‐American patients to obtain better insights into the management of nocturia in different Western healthcare systems.MethodsData were drawn from the “LUTS Disease Specific Programme,” a real‐life survey of physicians and patients in France, Germany, Spain, UK and the USA. Physicians completed a patient record form for lower urinary tract symptoms (LUTS) patients. Patients filled out a self‐completion form, indicating – among other items – information on the mean number of day‐ and night‐time voids during the last 7 days, and questions on the management of LUTS in daily practice.ResultsIn total, 8659 patients were analysed. The majority of patients initially consulted a physician because of worsening of LUTS frequency (43%–58%) or severity (44%–55%). Only 37% of all LUTS diagnoses, regardless of the appearance or severity of nocturia, were based on bladder diaries. Patients took approximately 1 year to consult a medical professional following the onset of LUTS. At the initial visit, most patients received advice on behavioural strategies. Regardless the type of LUTS and physician, 59% of men received α‐blockers and 76% of women antimuscarinics.ConclusionsData show that patients with nocturia and LUTS accept their symptoms for a considerable period before they seek help or ultimately receive treatment. They may therefore be enduring significant negative impact on their quality‐of‐life which could be avoided. Physicians rarely use bladder diaries and primarily use antimuscarinics (women) or α‐blockers (men). Improved awareness of nocturia among patients and physicians could improve the management of nocturia.

International Continence Society consensus on the diagnosis and treatment of nocturia

“…The real‐life diagnostic and therapeutic pathways for nocturia patients, based on the underlying causes of nocturia, are summarized in Figure . There was a consensus that we should treat bothersome nocturia but there was no consensus on whether this should be confined to two or more voids per night, or include any level of nocturia.…”

“…There is ample evidence that treating heart conditions, increasing physical activity, salt restriction, losing weight, and preventing edema treats nocturia …”

“…Nocturia guidelines are mainly hidden within broader LUTS guidelines because nocturia has historically been linked primarily to OAB and BPO, even though its main cause is nocturnal polyuria (NP) . A one‐year delay between onset of LUTS symptoms and consultation of a medical professional has been reported . Patients with nocturia are treated by healthcare providers from numerous different disciplines because nocturia is prevalent in many other conditions, such as cardiovascular disease, diabetes, and OAB.…”

“…However, desmopressin is the only evidence‐based pharmaceutical therapy for nocturia . Despite this, the breadth of its use in clinical practice is limited . Patients with nocturia have to face many hurdles before being diagnosed properly and treated with desmopressin, instead of OAB/BPO medication .…”

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.…”