“I am up all night” is a complaint voiced by many of my patients, both male and female patients.  But when I hear this, I know that they are not saying they are continuously awake all night but that they are up enough times to make it feel like they never got to sleep at all.  When asked why, this complaint usually translates to a prevalent symptom, nocturia, when you get up more than two times per night to urinate. 
I have been struck by the results of a recent Harris Poll national online survey of 2,040 U.S. adults, on the effect of nocturia, awakening one or more at night to urinate.  Their data shows that nocturia is not only a nighttime problem. 61% of nocturia sufferers noted that daytime activity and function were negatively impacted by their lack of sleep as 42% of sufferers feel drowsy, 21% site irritability, 17% are unable to perform or function and 15% report inability to concentrate. 
After reading a front-page article, How Profiteers Coax Women Into Surgery, in the New York Times, I knew I had to write this blog. The article describes the business case for exploiting women who have had a mesh implant for surgical treatment of pelvic floor disorders, e.g. pelvic organ prolapse, urinary incontinence. The author notes “Litigation against implants’ manufacturers has involved more than 100,000 plaintiffs in federal court alone.”   But we know that not all women who undergo mesh-implant surgery have mesh-related post-operative complications.
This was a quote from a patient who was treated for bothersome nocturia with a new formulation of desmopressin acetate (Noctiva).  Nocturia - awakening to urinate - is an all too common symptom reported by both men and women.  This is a commonly reported symptom in patients who report other lower urinary tract symptoms, such as incontinence, urgency and daytime frequency, but I also hear it from male patients who have benign prostatic hyperplasia (BPH).  It can be part of the overactive bladder (OAB) syndrome but unlike other symptoms, I have not been very successful in my behavioral or drug treatments.  Daytime symptoms seem to respond to these interventions but nighttime voiding- nocturia - is an outlier.  
I want to share with you the story of my approach to two of my patients being seen for overactive bladder symptoms of urgency and frequency during the day and night. I thought you might be interested in their stories as what I found to be successful treatments were not an approach often recommended. Their symptoms had defied most treatments.

The first patient was James, a 74-year-old man who was referred for Percutaneous tibial nerve stimulation (PTNS) treatments, having failed 2 injections of Botox and multiple overactive bladder (OAB) medications. He had refused an Interstim implant. James was tolerating his
Nocturia is a symptom reported by patients way too often.  As an expert in urology, I see the impact that nocturia has on both men and women, many of whom have been seeking help for a long time. I am leading this Center of Excellence to broaden awareness of nocturia and bring new treatments to patients. My practice is a tertiary, specialized practice and most of my patients have seen multiple providers prior to being referred. In the case of nocturia, roughly 40% do not see an improvement in symptoms with current treatments, although these treatments improve other bladder-related symptoms. People arrive in my office, desperately seeking relief from getting up in the middle of the night – twice or more – to urinate.

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