Nocturia: current status and future perspectives

Nocturia is a bothersome and highly prevalent condition characterized by the need to wake to void at night. Nocturia is equally common in men and women, and although its prevalence increases with age, a significant proportion of younger people are also affected. Nocturia leads to fragmentation of sleep and consequently to a serious decline in daytime functioning and in quality of life and health. Its impact should not be underestimated by clinicians and therefore a review on nocturia is timely and relevant.

Traditionally, nocturia is regarded as a symptom of benign prostatic enlargement and/or overactive bladder syndrome, with treatment therefore directed toward increasing the capacity of the bladder to hold urine. Such treatments have proven ineffective in many patients because nocturnal polyuria, an overproduction of urine at night, has been found to be present in the majority of patients. Nocturia can be attributed to some underlying pathological factors but it can also be a distinct clinical entity with specific pathogenesis. Frequency-volume charts are recommended for routine use in clinical practice, to determine whether nocturia is a result of excessive urine production at night, or of small voided volumes due to bladder problems, or a combination of these factors. Desmopressin, a synthetic analogue of the antidiuretic hormone, should be considered in patients with nocturia where nocturnal polyuria is present.

Contrary to popular and medical misconception nocturia is an important condition leading to general morbidity and with serious impact on overall quality of life and health. We advise clinicians to pay attention to nocturia and diagnostics should be offered. Treatment modalities are available and have to be discussed with the patient.