Beyond the Abstract - The evaluation and treatment of nocturia: A consensus statement, by Jeffrey P. Weiss, MD, FACS

BERKELEY, CA (UroToday.com) - In April, 2010, a 2-day interdisciplinary conference on nocturia was convened by the New England Research Institutes, Inc. in Cambridge, MA.

Leading experts in the fields of urology, urogynecology, psychometrics, primary care and sleep physiology met to present the state of the science of nocturia.

It was concluded that nocturia is a highly multi-factorial condition that can exert a range of deleterious effects on health. Rather than being viewed simply as a secondary symptom of other conditions, nocturia should be recognized as a condition in its own right with potentially profound consequences for well-being, longevity and functioning. Voiding diaries are the most useful initial diagnostic tools for evaluating nocturia and should be used wherever possible, and early in the diagnostic process, to most accurately characterize the causes of nocturia in each patient. Treatment of nocturia with alpha 1-blockers and/or anticholinergics is not generally effective despite the finding of statistically significant improvements in symptoms, whose clinical significance is essentially nil. Still to be determined is the role of anticholinergics in nocturic patients whose night time awakenings are characterized by urgent voiding. Timed diuretics given at mid-afternoon may be effective in patients with third spacing as an etiology for nocturia. Antidiuretic therapy (e.g. desmopressin) has proven well-tolerated and effective in several randomized, placebo-controlled trials and is recommended as a first-line treatment (either as monotherapy or in combination with other agents) for patients who have been appropriately evaluated and whose nocturia is related to nocturnal polyuria - whether or not accompanied by BPH or OAB. However, it is possible that antidiuretic therapy can be useful in patients with diminished nocturnal bladder capacity if the action is to better match nocturnal urine production with nocturnal capacity.

Further research is warranted to determine the ideal setting for therapy of nocturia with both desmopressin and anticholinergics. Surgical options such as TURP or laser prostatectomy to remove or reduce prostatic or urethral obstruction may also improve nocturia. Herbal supplements, such as saw palmetto berry extract, have not been well studied and, while potentially helpful in some individuals, cannot be recommended at this time.

 

Written by:
Jeffrey P. Weiss, MD, FACS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

The evaluation and treatment of nocturia: A consensus statement - Abstract

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