Current Evaluation and Treatment of Nocturia

Abstract

Nocturia is usually considered to be just one of the symptoms included with lower urinary tract symptoms (LUTS) and is treated with therapy based on LUTS. Recent research suggests, however, that nocturia is not merely a simple symptom of LUTS but is a multifactorial condition with many contributing etiological factors. The causes of nocturia can be classified into bladder storage problems, increased urine output, sleep disturbance problems, and other potential diseases. The frequency-volume chart (FVC) is very important in evaluating and diagnosing nocturia. Patients usually record the volume and timing of voids for a period of 1 to 3 days on the FVC. The FVC data can provide information on voiding patterns and clues about the etiology and treatment of nocturia. It is doubtful that alpha-blockers will have clinical significance for treatment because the difference in nocturia episodes between treatment with alpha-blockers and placebo is too small. Antimuscarinics also exert no effect on nocturnal polyuria, and the evidence supporting the efficacy of antimuscarinics for the treatment of nocturia is limited. However, several randomized placebo-controlled trials have shown the efficacy of oral desmopressin in the treatment of adults with nocturia. Short-acting hypnotics may be helpful for patients with sleep disturbances. Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate appears to confer a greater improvement in benign prostatic hyperplasia symptoms including nocturia. The management of nocturia may require a team approach by making optimal use of multidisciplinary expertise.

Nocturia Improvement With Surgical Correction of Sleep Apnea

“…Except in the case of nocturnal polyuria, nocturia has usually been managed as an isolated symptom, with therapy based on LUTS, including alpha blockers and anticholinergic drugs. Recent research suggests, however, that the etiology of nocturia differs from that of other LUTS, and that nocturia should be evaluated as a separate condition, as well as a component of a systemic disease [6]. …”

Therapeutic Efficacy and Safety of Oral Desmopressin for Nocturia in the Elderly Patient

“…Thus, in our study there was a significant decrease in nocturnal urine volume compared to baseline, both during the first week and the control performed within three months of initiation of therapy, which led to a decrease in the number of nocturnal voids and consequently a statistically significant increase in the time to first micturition. These last two aspects (number of night-time micturitions and NUV) are considered by many authors the key points of treatment effectiveness [21]. Likewise, prolonging the time until the first micturition is considered a very important quality of life factor, as in the first half of sleep there is an increase in the proportion of so-called "delta sleep", which represents the sleep phase that most contributes to the feeling of having slept well [22].…”

Desmopressin for nocturia in adults

“…The number of people having two or more voids per night has been reported as 2–17% of men and 4–18% of women aged 20–40 years, increasing to 29–59% of men and 28–62% of women aged over 70 years 8. There are various potential contributory factors, including sleep apnoea, sleep disorders and diuretic intake in the evening 5,8.…”

“…There are various potential contributory factors, including sleep apnoea, sleep disorders and diuretic intake in the evening 5,8. Assessment requires taking a thorough history and clinical examination to identify underlying disease.…”

“…Nocturia may be caused by reduced bladder capacity or increased urine output (polyuria, which may be due to diabetes mellitus or diabetes insipidus) or production of an abnormally large amount of urine at night (nocturnal polyuria) 5,8. The natural diurnal variation in vasopressin secretion means that urine production is normally reduced at night.…”