Nocturia: a non-specific but important symptom of urological disease

Nocturia is a prevalent symptom that can adversely affect quality of sleep and overall quality of life leading to morbidity and even mortality. Nocturia can be due to a range of urological conditions and non-urological diseases. Nocturia can be due to an insufficient bladder capacity and/or (nocturnal) polyuria. Some of the possibly underlying non-urological diseases can be life-threatening, implying treatment priorities. Urological treatment options include alpha-adrenoceptor antagonists, muscarinic receptor antagonists and vasopressin receptor agonists. The former two have shown beneficial but small and inconsistent effects in patients assumed to have benign prostatic hyperplasia or overactive bladder, respectively. In contrast, the vasopressin analog desmopressin has consistently shown nocturia improvement in patients with proven polyuria. While supported by lower levels of evidence, lifestyle modifications are generally considered important for nocturia treatment. We conclude that nocturia is a urinary storage symptom with a major impact on patients' lives and a complex pathophysiology.