TANGO ‐ a screening tool to identify comorbidities on the causal pathway of nocturia

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Introduction Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. Methods Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence‐Research Society (ICI‐RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI‐RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). Results Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate‐specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow‐up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. Conclusion A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.

Section: Resultsmentioning

confidence: 99%

Section: Diagnostic Packagesmentioning

confidence: 99%

International Continence Society consensus on the diagnosis and treatment of nocturia

Everaert

Hervé

Bosch

et al. 2019

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104

“…Explanatory notes on definitions have been referred, where possible, to the “footnotes” section. This document does not address the epidemiology, pathophysiology or treatment of nocturia or any of its sub‐categories, as that is not the main aim of the Standardisation Steering Committee (SSC) or the nocturia working group, is beyond the scope of this article, and is covered in several other publications …”

Section: Introductionmentioning

confidence: 99%

“…This document does not address the epidemiology, pathophysiology or treatment of nocturia or any of its sub-categories, as that is not the main aim of the Standardisation Steering Committee (SSC) or the nocturia working group, is beyond the scope of this article, and is covered in several other publications. 2,3,[6][7][8][9][10][11] Like all other joint ICS terminology reports, every effort has been made to ensure this report is:…”

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confidence: 99%

International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function

Hashim

Blanker

Drake

et al. 2019

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Introduction The terminology for nocturia and nocturnal lower urinary tract function is reviewed and updated in a clinically and practically‐based consensus report. Methods This report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardisation Steering Committee (SSC). All relevant definitions were updated on the basis of research over the last 16 years since the publication of the first nocturia standardization document in 2002. An extensive process of 16 rounds of internal and external reviews was involved to examine each definition exhaustively, with decision‐making by collective opinion (consensus). Results A clinically‐based terminology report for nocturia and nocturnal lower urinary tract function, encompassing five key definitions divided into signs and symptoms has been developed. Clarity and user‐friendliness have been key aims to make it interpretable by healthcare professionals and allied healthcare practitioners involved in the care of individuals with nocturnal lower urinary tract function. Conclusion A consensus‐based terminology report for nocturia and nocturnal lower urinary tract function has been produced to aid clinical practice and research.

“…Clearly, the screening and diagnostic process for nocturia should include aspects of sleep onset, initial duration of restorative sleep and events that may disturb sleep (such as pain, uncomfortable breathing and efforts to achieve thermoregulation). A measure that would be helpful in identifying factors contributing to sleep dysfunction in nocturia patients has recently been described . Ideally assessment will also capture the impact of regular nocturia on day to day function.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal voiding frequency does not describe nocturia‐related bother

Rose

Denys

Kumps

et al. 2019

Self Cite

Aim Nocturia frequency has been used as a measure of treatment efficacy for nocturia even though fluctuation of the symptom over time has been well described in the literature. Additionally, given the multifactorial causal pathway and clinically relevant comorbidities, frequency alone may be an insufficient marker of treatment direction. The aim of this study was to investigate factors associated with nocturia‐related bother to identify additional variables that may capture the impact of nocturia, direct clinical care and have potential to quantify treatment outcome. Methods Prospective data from tertiary hospital Urology and Continence cohorts were matched for identical variables to generate a sample of 204 datasets. Descriptive statistics were obtained to describe the two cohorts. Characteristics of patients were evaluated across levels of nocturia frequency and nocturia‐related bother using nonparametric methods; statistically significant differences between groups in each cohort were established. Results Nocturia frequency alone does not comprehensively reflect attributable bother. Five sleep variables (poor quality sleep, short time to first awakening to void, less than 7 hours of total sleep, primary sleep latency, and daytime sleepiness) and daily urinary urgency were significantly associated with high nocturia‐related bother. Attributable bother, despite high‐frequency nocturia, was minimized by male gender, lack of daily urinary urgency and good sleep quality. Poor health status, urinary urgency and sleep latency were associated with nocturia frequency. Conclusions Items of importance to individuals with nocturia have been identified from patient data. These variables have the potential to sit alongside change in nocturia frequency as potential markers of treatment response.