Nocturia - Symptom or a Disease?

Waking at night to void is known as nocturia and it is a common condition experienced by both men and women with profound impact on patient's health, quality of life, and economic condition. It is often perceived as a symptom of an organic disease, but the pathophysiology of nocturia is now well-understood, and it is considered as a disease itself. It is classified based on four different pathophysiologic mechanisms (24-hour polyuria, nocturnal polyuria, reduced bladder capacity, and sleep disorders). The association of nocturia with impaired quality of life, cardiovascular morbidity and all-cause mortality is well established. Various pharmacological agents are available, of which desmopressin is considered safe and effective in both short- and long-term studies for the treatment of nocturia in men and women, including the elderly. Combining desmopressin with other agents provides an effective treatment option for nocturia in patients with lower urinary tract symptoms, benign prostatic hypertrophy or overactive bladder syndrome. This review covers the various aspects of pathophysiology and impact of nocturia, as well as the treatment of nocturia. We present the novel concept of a "nocturia clinic", which is a comprehensive diagnostic and management center for patients with nocturia. This set-up may help bring about a positive change in the underreported and undertreated status of nocturia, and bring relief to sufferers of nocturia. Therefore nocturia though perceived as a symptom of many disorders; it itself has a defined pathophysiology and needs treatment.