Nocturia research: current status and future perspectives

This review summarizes the status of nocturia research, highlighting the condition's distinct nature, as well as areas where further studies are needed. Unlike other LUTS, nocturia has a specific and detrimental effect on the sleep period, and when >or=2 voids per night are experienced it is associated with various sequelae including reduced QoL and productivity, and increased morbidity and perhaps mortality. Many sources suggest that nocturia is associated with chronic medical illness, but little evidence demonstrates that successful treatment of these conditions results in normalization of nocturia, or that improvement in nocturia improves QoL and overall health. To date, management algorithms for LUTS have been based upon reasonable supposition and limited evidence, rather than controlled trials. Whilst a working clinical model is useful until conclusive research is available, a healthy scepticism should be maintained. It is likely that more than one contributory factor is responsible for nocturia, and management ought to better reflect this multifactorial pathophysiology. Indeed, traditional perspectives assuming nocturia to be part of the OAB or BPE symptom complex may have helped to propagate the misconception that therapy for these conditions is sufficient to improve nocturia. In reality, improvements in nocturia with anticholinergics, alpha-blockers and/or 5-alpha reductase inhibitors have been consistently disappointing. Antidiuretic therapy may represent a more tailored approach to management for many nocturia patients, given the high rates of nocturnal polyuria reported. Combination therapy may be required. Further high quality research on pathophysiology, management and patient-reported outcomes with treatment is needed to augment existing limited data.