We are in the middle of a very exciting time treating Lower Urinary Tract Symptoms (LUTS).  The primary reason for this excitement is the new medical treatments that are available and on the horizon.  With most pharmacologic therapies, there are going to be "responders",  and some patients that fall short of the desired efficacy.  Some patients will tolerate therapies well, and others may have issues with unwanted side-effects. Patients can have multiple etiologies that result in their clinical symptom(s).  For these reasons, we desire varied tools in our armamentarium.  Having choices of effective medicines to provide will help alleviate our patients’ suffering, and improve their quality of life.  

The recently published article Lower Urinary Tract Symptoms: What’s New in Medical Treatment? in the European Urology Focus Review explores some of these new treatments.  This was prepared, with co-authors, Dr. Peyronnet and Dr. Michel, to review
Very often when a man is diagnosed with prostate cancer we consider how our therapies effect different aspects of their health and quality of life. However holistic we have become one area that we have not been as considerate about is the impact our therapies have on sleep and the subsequent impact sleep disturbance.

Thanks to Gonzalez et al. we now have data that suggest we need to look at this impact. Recently published in cancer the study compares objective and subjective sleep disturbance in patients with prostate cancer receiving androgen deprivation therapy (ADT) compared with patients with prostate cancer previously treated with surgery only as well as men without a cancer history. 
For a longtime we have the impression that getting up to void at night a normal part of aging. Even when more severe, and our patients bring the impact to our attention, we largely ignore the subject. In some cases, a few general recommendations (e.g. drink less fluid before bed) may be made, perhaps a medication to treat another condition (e.g. OAB, BPH) is prescribed, and the patient is left without relief.

I think of Nocturia as the “forgotten lower urinary tract condition”. Our understanding of sleep has recently come a long way, we are only now starting to understand the homeostatic effects of sleep. We now realize the impact of sleep quality on many domains of health and well-being. It is therefore more important than ever to address conditions that are have a negative impact on sleep and sleep quality. We need to realize that Nocturia is no longer just a symptom, but rather a condition with profound impact, regardless of age.