Dr. Weiss introduced 4 primary types of nocturia: nocturnal polyuria (NP), diminished global/nocturnal bladder capacity (NBC), mixed, and polyuria. Possible causes of NP included sleep apnea, diuretics, SSRIs, calcium channel blockers, tetracycline, and lithium.
Voiding diary was presented as a great tool for the classification of disease etiology. Evaluation of nocturia is based on the analysis of a simple 24-hour diary of voids documented by patient. Voiding diary analysis can reveal up to 19 underlying medical conditions, which could be linked to disease emergence. However, there is a question about the most feasible type of diary used for diagnostic purposes: 24-hour FVC, complete 24h, nocturnal only, or nocturnal only plus 24h volume. Review of real-life case studies showed that correct choice depends on disease characteristics, but nocturnal only plus 24h volume diary was named to be the best option (Figure 2).
Multiple studies on antidiuretics were presented during the overview. Desmopressin melt (tablet) was proven to decrease nocturnal voids and improved sleep (Figure 3). Noctiva, desmopressin acetate nasal spray, was recommended to use in adults over 50 years of age with polyuria who awaken at least 2 times per night to void.
Finally, Dr. Weiss presented an idea that nocturia can be a symptom of hypertension. Studies demonstrate that non-dipping nocturnal blood pressure can be a factor behind developing nocturnal episodes. It has been found that bedtime dosing of hypertension medications can help in decreasing nocturnal blood pressure, particularly a combination of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs), but it is not yet confirmed that decrease in nocturnal blood pressure will reduce nocturic episodes. Research shows that both treated hypertension and treated, but uncontrolled are risk factors behind nocturia (Figure 4).
In conclusion, Dr. Weiss presented a multifactorial nature of nocturia and proposed treatment guidelines based on disease characteristics (Figure 5).
Presented by: Jeffrey P. Weiss, MD, FACS, Department of Urology, SUNY Downstate Medical Center
Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania, Twitter: @AStambakio at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida