Diagnosis and treatment of nocturia in resource-limited settings: An expert panel consensus for the Malaysian context

Patients with nocturia often experience delays or misdiagnosis. Tailored guidance for the Malaysian context, especially in resource-limited settings, is essential for effective treatment. This consensus aimed to establish practical definitions, standardized diagnostics and management for nocturia, and a simple desmopressin use algorithm for adults.

A literature review was conducted to identify clinical publications from January 2010 to December 2023. Thirty-five statements were developed using the Delphi method, with reference to the International Continence Society Consensus. For statements lacking consensus, the GRADE-ADOLOPMENT method was used.

Experts reached a consensus on defining nocturia and nocturnal polyuria. Nocturia is considered bothersome when it involves ≥2 awakenings per night, particularly if impacting sleep and quality of life. Recommended assessments include history-taking, physical examination, and essential clinical workups. A bladder diary is essential at the first clinical presentation. For older men, additional evaluations such as blood pressure measurement, digital rectal examination, and post-void residual urine measurement may be necessary. The Targeting the individual's Aetiology of Nocturia to Guide Outcomes Short-Form (TANGO-SF) questionnaire is recommended alongside a bladder diary for capturing the multifaceted nature of nocturia and its comorbidities. Treatment includes lifestyle modifications and pharmacotherapy tailored to individual needs. Special caution is advised for patients with heart failure and frailty. Sex-specific dosing of desmopressin is recommended for nocturia due to nocturnal polyuria, with baseline serum sodium levels ≥135 mmol/L before initiation. Serum sodium levels should be monitored during treatment and therapy should be adjusted as necessary.

Consensus was reached on practical definitions and standardized methods for diagnosing and managing nocturia in Malaysia, which are also applicable to other resource-limited settings.