A practical approach to the management of nocturia
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Aim: To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways. Methods: A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences. Results: 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. Conclusions: 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.
Date Issued
2017-11
Date Acceptance
2017-09-11
Citation
International Journal of Clinical Practice, 2017, 71 (11), pp.1-11
ISSN
1368-5031
Publisher
Wiley
Start Page
1
End Page
11
Journal / Book Title
International Journal of Clinical Practice
Volume
71
Issue
11
Copyright Statement
© 2017 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
License URL
Identifier
https://onlinelibrary.wiley.com/doi/10.1111/ijcp.13027
Notes
keywords: assessment of healthcare needs, desmopressin, expert opinion, morbidity, mortality, nocturia, pathophysiology
Publication Status
Published
Article Number
e13027
Date Publish Online
2017-10-05