A practical approach to the management of nocturia

To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.

A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.

Nocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged 70-80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia-related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency-volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low-dose, gender-specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid-late afternoon, dependent on the specific serum half-life. Patients not responding to these basic treatments should be referred for specialist management.

The cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.

International journal of clinical practice. 2017 Oct 05 [Epub ahead of print]

Matthias Oelke, Stefan De Wachter, Marcus J Drake, Antonella Giannantoni, Mike Kirby, Susan Orme, Jonathan Rees, Philip van Kerrebroeck, Karel Everaert

Department of Urology, University of Maastricht, Maastricht, The Netherlands., Department of Urology, University of Antwerp, Antwerp, Belgium., Department of Urology, University of Bristol, Bristol, UK., Department of Surgical and Biomedical Sciences, Urology and Andrology Unit, University of Perugia, Perugia, Italy., The Centre for Research in Primary and Community Care, The University of Hertfordshire and The Prostate Centre, London, UK., Department of Geriatric Medicine, Barnsley Hospital NHS Foundation Trust Hospital, Barnsley, UK., Backwell and Nailsea, North Somerset, UK., Department of Urology, Ghent University Hospital, Ghent, Belgium.