Nocturia: Current Evaluation and Treatment for Urology

Abstract

Nocturia is a very common yet a highly underreported entity. Recently, there has been an increasing interest in nocturia because of its association with serious adverse health conditions such as diabetes, heart disease, elevated BMI, and mortality. Frequency volume charts are the cornerstone of initial assessment and are pivotal in determining the type of nocturia and associated causes. The diagnostic evaluation is aimed at clarifying the underlying cause: sleep disturbances, reduced bladder capacity (functional or extrinsic), and increased urine production (nocturnal or daily). Obstructive sleep apnea is an important cause of nocturnal polyuria and should always been considered. Management is focused on treating the underlying cause; a range of behavioral and pharmacologic options are available.

Nocturia as a marker of poor health: Causal associations to inform care

“…Current practice in urology and continence services is to obtain a 3 day Frequency Volume Chart, prostate symptom score, urinalysis (and possibly urine culture), uroflowmetry, and estimate bladder emptying efficiency. Some authors suggest screening for hours slept before first night void and measuring health‐related quality of life . Data from this study suggest such evaluation of nocturia may not uncover all causes of the symptom.…”

Basic or extended urine sampling to analyse urine production?

“…14,15 International guidelines recommend that the initial step in the assessment of patients seeking help for troublesome nocturia should focus on whether or not NP is present. 13 A more detailed diagnostic work-up in enuretic children and nocturic adults with NP has clearly shown considerable variations in water and solute excretion, with the identification of three categories: disorders in circadian rhythms of water diuresis, solute diuresis (mainly sodium) or a combination of both mechanisms. 1,11,12 It seems logical that treatment of patients with bothersome symptoms as a result of NP requires an individualised adaptation according to the underlying cause.…”

A practical approach to the management of nocturia

“…Athoroughassessmentofnocturiaanditspossiblecausesiscrucialbeforetreatmentinitiation(Table2;alsoseeChecklistavailableas onlinematerial). 32,[52][53][54] The evaluation of a patient should begin with takingathoroughhistorytoassess,understandanddiscriminateLUTS in general and nocturia in particular. 36 FVCs also help to target specific non-urologic aetiologies.…”