A practical approach to the management of nocturia

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

49 Citations (Web of Science)

Abstract

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

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

ResultsNocturia 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 20-40years, rising to 28%-62% for those aged 70-80years. 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 Euro1 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.

ConclusionsThe 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.

Original languageEnglish
Article number13027
Number of pages11
JournalInternational Journal of Clinical Practice
Volume71
Issue number11
DOIs
Publication statusPublished - Nov 2017

Keywords

  • assessment of healthcare needs
  • desmopressin
  • expert opinion
  • morbidity
  • mortality
  • nocturia
  • pathophysiology
  • URINARY-TRACT SYMPTOMS
  • QUALITY-OF-LIFE
  • ORALLY DISINTEGRATING TABLET
  • PLACEBO-CONTROLLED TRIAL
  • STANDARDIZATION SUB-COMMITTEE
  • BENIGN PROSTATIC HYPERPLASIA
  • OVERACTIVE BLADDER SYMPTOMS
  • OBSTRUCTIVE SLEEP-APNEA
  • ADD-ON THERAPY
  • DOUBLE-BLIND

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