Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Bladder Dysfunction Reports
Published in: Current Bladder Dysfunction Reports 4/2019

01-12-2019 | Pharmacotherapies and Drug Development/Agents (ES Rovner, Section Editor)

Nocturia: Evaluation and Management

Authors: Curran J. Emeruwa, Danielle J. Gordon, Jeffrey P. Weiss

Published in: Current Bladder Dysfunction Reports | Issue 4/2019

Login to get access

Abstract

Purpose of Review

Nocturia, defined as waking to pass urine during the main sleep period, is among the most common and bothersome lower urinary tract symptoms. In this review, the current literature as it pertains to the etiology, evaluation, and management of nocturia is addressed.

Recent Findings

Over the past decade, there has been increased interest in nocturia as a specific lower urinary tract symptom, with efforts made to improve understanding of underlying mechanisms and consequences. Several publications now classify nocturia according to underlying cause (such as nocturnal polyuria), in that what was a previously overlooked and understudied topic, emerges as a distinct urinary complaint carrying significant morbidity. Multiple randomized controlled trials demonstrate effective medical and surgical therapy and provide the basis for modern guidelines.

Summary

Nocturia is a highly prevalent symptom associated with reduced quality of life, morbidity, and mortality. Proper evaluation including analysis of a frequency-volume chart, will determine treatment options based on underlying etiology including nocturnal polyuria, global polyuria, and reduced bladder capacity. Desmopressin is shown to be an effective treatment for nocturnal polyuria. Evidence supporting other treatment options including surgical intervention, α-blockers, and antimuscarinics remains limited. Further research is needed to integrate and emphasize the importance of a proper evaluation of nocturia and its subsequent management for use in modern guidelines.
Literature
1.
Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V, et al. International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function. Neurourol Urodyn. 2019;38(2):499–508.PubMed
2.
•• Kupelian V, Wei JT, O’Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol. 2012;61(1):78–84 Study describing nocturia as a strong predicator of mortality. PubMed
3.
Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol. 2011;185(2):571–7.PubMed
4.
Nakagawa H, Niu K, Hozawa A, Ikeda Y, Kaiho Y, Ohmori-Matsuda K, et al. Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol. 2010;184(4):1413–8.PubMed
5.
Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK. Nocturia and disturbed sleep in the elderly. Sleep medicine. 2009 May 1;10(5):540–8.PubMed
6.
Yoshimura K, Oka Y, Kamoto T, Tsukamoto T, Oshiro K, Suzukamo Y, et al. Night-time frequency, sleep disturbance and general health-related quality of life: Is there a relation? Int J Urol. 2009;16(1):96–100.PubMed
7.
Bliwise DL, Holm-Larsen T, Goble S, Nørgaard JP. Short time to first void is associated with lower whole-night sleep quality in nocturia patients. J Clin Sleep Med. 2015;11(01):53–5.PubMedPubMedCentral
8.
Tasali E, Leproult R, Ehrmann DA, Van Cauter E. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci. 2008;105(3):1044–9.PubMed
9.
Hall MH, Muldoon MF, Jennings JR, Buysse DJ, Flory JD, Manuck SB. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008;31(5):635–43.PubMedPubMedCentral
10.
Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep. 2014;37(2):239–44.PubMedPubMedCentral
11.
Swanson LM, Arnedt JT, Rosekind MR, Belenky G, Balkin TJ, Drake C. Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll. J Sleep Res. 2011;20(3):487–94.PubMed
12.
•• Bosch JR, Weiss JP. The prevalence and causes of nocturia. J Urol. 2010;184(2):440–6 Study showing high prevalence of nocturia in the general population. PubMed
13.
Hirayama A, Torimoto K, Mastusita C, Okamoto N, Morikawa M, Tanaka N, et al. Evaluation of factors influencing the natural history of nocturia in elderly subjects: results of the Fujiwara-kyo Study. The Journal of urology. 2013 Mar;189(3):980–6.PubMed
14.
van Doorn B, Blanker MH, Kok ET, Westers P, Bosch JR. Prevalence, incidence, and resolution of nocturnal polyuria in a longitudinal community-based study in older men: the Krimpen study. Eur Urol. 2013;63(3):542–7.PubMed
15.
Yoshimura K. Correlates for nocturia: a review of epidemiological studies. Int J Urol. 2012;19(4):317–29.PubMed
16.
Burgio KL, Johnson TM II, Goode PS, Markland AD, Richter HE, Roth DL, et al. Prevalence and correlates of nocturia in community-dwelling older adults. J Am Geriatr Soc. 2010;58(5):861–6.PubMedPubMedCentral
17.
Gulur DM, Mevcha AM, Drake MJ. Nocturia as a manifestation of systemic disease. BJU Int. 2011;107(5):702–13.PubMed
18.
Liao CH, Chiang HS, Yu HJ. Serum testosterone levels significantly correlate with nocturia in men aged 40-79 years. Urology. 2011;78(3):631–5.PubMed
19.
McKeigue PM, Reynard JM. Relation of nocturnal polyuria of the elderly to essential hypertension. Lancet. 2000;355(9202):486–8.PubMed
20.
Vaughan CP, Johnson TM II, Goode PS, Redden DT, Burgio KL, Markland AD. Vitamin D and lower urinary tract symptoms among US men: results from the 2005-2006 National Health and Nutrition Examination Survey. Urology. 2011;78(6):1292–7.PubMed
21.
Tikkinen KA, Auvinen A, Tiitinen A, Valpas A, Johnson TM II, Tammela TL. Reproductive factors associated with nocturia and urinary urgency in women: a population-based study in Finland. Am J Obstet Gynecol. 2008;199(2):153–e1.PubMed
22.
Van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):179–83.PubMed
23.
Yap TL, Cromwell DA, Brown C, Van der Meulen J, Emberton M. The relationship between objective frequency–volume chart data and the I-PSS in men with lower urinary tract symptoms. Eur Urol. 2007;52(3):811–8.PubMed
24.
Asplund R. The nocturnal polyuria syndrome (NPS). Gen Pharmacol. 1995;26(6):1203–9.PubMed
25.
Matthiesen TB, Rittig S, Norgaard JP, Pedersen EB, Djurhuus JC. Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms. J Urol. 1996;156(4):1292–9.PubMed
26.
Blanker MH, Bernsen RM, Bosch JR, Thomas S, Groeneveld FP, Prins AD, et al. Normal values and determinants of circadian urine production in older men: a population based study. J Urol. 2002;168(4):1453–7.PubMed
27.
van Doorn B, Bosch J.L.H.R. Diary-based population analysis of nocturia in older men: findings of the Krimpen study. In: Weiss JP, Blaivas JG, Van Kerrebroeck PEV, Wein AJ, editors. Nocturia: causes, consequences and clinical approaches. Springer Science & Business Media; 2011. p. 59–76.
28.
Weiss JP, van Kerrebroeck PE, Klein BM, Nørgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol. 2011;186(4):1358–63.PubMed
29.
Weiss JP, Ruud Bosch JL, Drake M, Dmochowski RR, Hashim H, Hijaz A, et al. Nocturia think tank: focus on nocturnal polyuria: ICI-RS 2011. Neurourol Urodyn. 2012;31(3):330–9.PubMed
30.
Tyagi S, Resnick NM, Perera S, Monk TH, Hall MH, Buysse DJ. Behavioral treatment of insomnia: also effective for nocturia. J Am Geriatr Soc. 2014;62(1):54–60.PubMedPubMedCentral
31.
Asplund R, Johansson S, Henriksson S, Isacsson G. Nocturia, depression and antidepressant medication. BJU Int. 2005;95(6):820–3.PubMed
32.
Otsuka K, Tanaka H, Horinouchi T, Koike K, Shigenobu K, Tanaka Y. Functional contribution of voltage-dependent and Ca2+-activated K+ (BKCa) channels to the relaxation of guinea-pig aorta in response to natriuretic peptides. J Smooth Muscle Res. 2002;38(4, 5):117–29.PubMed
33.
Guzzo JO, Cox M, Kelley AB, Singer I. Tetracycline-induced inhibition of Na+ transport in the toad urinary bladder. Am J Physiol. 1978;235(4):F359–66.PubMed
34.
Marples D, Christensen S, Christensen EI, Ottosen PD, Nielsen S. Lithium-induced downregulation of aquaporin-2 water channel expression in rat kidney medulla. J Clin Invest. 1995;95(4):1838–45.PubMedPubMedCentral
35.
Reynard JM, Cannon A, Yang Q, Abrams P. A novel therapy for nocturnal polyuria: a double-blind randomized trial of furosemide against placebo. Br J Urol. 1998;81(2):215–8.PubMed
36.
Guilleminault C, Lin CM, Goncalves MA, Ramos E. A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia. J Psychosom Res. 2004;56(5):511–5.PubMed
37.
FitzGerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol. 2006;194(5):1399–403.PubMed
38.
• Victor RG, Li N, Blyler CA, Mason ON, Chang LC, Moy NP, et al. Nocturia as an unrecognized symptom of uncontrolled hypertension in black men aged 35 to 49 years. J Am Heart Assoc. 2019;8(5):e010794 Uncontrolled hypertension as an independent determinant of clinically important nocturia. PubMedPubMedCentral
39.
Feldstein CA. Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association. J Am Soc Hypertens. 2013;7(1):75–84.PubMed
40.
41.
Asplund R, Åberg H. Diurnal variation in the levels of antidiuretic hormone in the elderly. J Intern Med. 1991;229(2):131–4.PubMed
42.
Andersson KE, Appell R, Cardozo LD, Chapple C, Drutz HP, Finkbeiner AE, et al. The pharmacological treatment of urinary incontinence. BJU Int. 1999;84:923–47.PubMed
43.
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67(6):1099–109.PubMed
44.
•• Weiss JP, Zinner NR, Klein BM, Nørgaard JP. Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. Neurourol Urodyn. 2012;31(4):441–7 Desmopressin is an effective and well-tolerated treatment for patients with nocturia. PubMed
45.
Sand PK, Dmochowski RR, Reddy J, van der Meulen EA. Efficacy and safety of low dose desmopressin orally disintegrating tablet in women with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J Urol. 2013;190(3):958–64.PubMed
46.
Weiss JP, Herschorn S, Albei CD, van der Meulen EA. Efficacy and safety of low dose desmopressin orally disintegrating tablet in men with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J Urol. 2013;190(3):965–72.PubMed
47.
• Kaminetsky J, Fein S, Dmochowski R, MacDiarmid S, Abrams S, Cheng M, et al. Efficacy and safety of SER120 nasal spray in patients with nocturia: pooled analysis of 2 randomized, double-blind, placebo controlled, phase 3 trials. J Urol. 2018;200(3):604–11 Study outlining hyponatremia rates in novel formulation of desmopressin. PubMed
48.
Rembratt A, Riis A, Norgaard JP. Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia. Neurourol Urodyn. 2006 Mar;25(2):105–9.PubMed
49.
Jones C, Hill J, Chapple C. Management of lower urinary tract symptoms in men: summary of NICE guidance. Bmj. 2010;340:c2354.PubMed
50.
Tsui J, Marshall S, Weiss J, Samson P, Weinberger J, Roudakova K, et al. Low bladder compliance is a risk factor for nocturia severity. J Urol. 2013;189(4S):e930.
51.
Housami F, Abrams P. Persistent detrusor overactivity after transurethral resection of the prostate. Curr Urol Rep. 2008;9(4):284–90.PubMed
52.
Yoshimura K, Ohara H, Ichioka K, Terada N, Matsui Y, Terai A, et al. Nocturia and benign prostatic hyperplasia. Urology. 2003;61(4):786–90.PubMed
53.
Margel D, Lifshitz D, Brown N, Lask D, Livne PM, Tal R. Predictors of nocturia quality of life before and shortly after prostatectomy. Urology. 2007;70(3):493–7.PubMed
54.
Platz EA, Smit E, Curhan GC, Nyberg LM Jr, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in US men. Urology. 2002;59(6):877–83.PubMed
55.
Johnson TM II, Jones K, Williford WO, Kutner MH, Issa MM, Lepor H. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. J Urol. 2003;170(1):145–8.PubMed
56.
Johnson TM, Burrows PK, Kusek JW, Nyberg LM, Tenover JL, Lepor H, et al. Medical therapy of prostatic symptoms research group. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J Urol. 2007;178(5):2045–51.PubMed
57.
Rackley R, Weiss JP, Rovner ES, Wang JT, Guan Z, STUDY GROUP. Nighttime dosing with tolterodine reduces overactive bladder-related nocturnal micturitions in patients with overactive bladder and nocturia. Urology. 2006;67(4):731–6.PubMed
58.
Nitti VW, Dmochowski R, Sand PK, Forst HT, Haag-Molkenteller C, Massow U, et al. Efficacy, safety and tolerability of fesoterodine for overactive bladder syndrome. J Urol. 2007;178(6):2488–94.PubMed
59.
Dmochowski RR, Peters KM, Morrow JD, Guan Z, Gong J, Sun F, et al. Randomized, double-blind, placebo-controlled trial of flexible-dose fesoterodine in subjects with overactive bladder. Urology. 2010;75(1):62–8.PubMed
60.
Herschorn S, Swift S, Guan Z, Carlsson M, Morrow JD, Brodsky M, et al. Comparison of fesoterodine and tolterodine extended release for the treatment of overactive bladder: a head-to-head placebo-controlled trial. BJU Int. 2010;105(1):58–66.PubMed
61.
Weiss JP, Jumadilova Z, Johnson TM, FitzGerald MP, Carlsson M, Martire DL, et al. Efficacy and safety of flexible dose fesoterodine in men and women with overactive bladder symptoms including nocturnal urinary urgency. J Urol. 2013;189(4):1396–401.PubMed
62.
Aydur E, Dmochowski R. Medical conditions associated with nocturia. In: Weiss JP, Blaivas JG, Van Kerrebroeck PEV, Wein AJ, editors. Nocturia: causes, consequences and clinical approaches. Springer Science & Business Media; 2011. p. 11–36.
63.
Tani M, Hirayama A, Torimoto K, Matsushita C, Yamada A, Fujimoto K. Guidance on water intake effectively improves urinary frequency in patients with nocturia. Int J Urol. 2014;21:595–600.PubMed
Metadata
Title
Nocturia: Evaluation and Management
Authors
Curran J. Emeruwa
Danielle J. Gordon
Jeffrey P. Weiss
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 4/2019
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-019-00557-0

Other articles of this Issue 4/2019

Current Bladder Dysfunction Reports 4/2019 Go to the issue

Cancer-Associated Voiding Dysfunction (S Elliott and J Pariser, Section Editors)

Vesicourethral Anastomotic Stenosis after Prostate Cancer Treatment

Cancer-Associated Voiding Dysfunction (S Elliott and J Pariser, Section Editor)

Rectourethral Fistula—Review of Current Practices, Developments, and Outcomes

Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)

Dilemmas in Management of the Geriatric Bladder

Overactive Bladder (U Lee and S Adelstein, Section Editors)

The Role of Local Hormone Replacement in Overactive Bladder

Stress Incontinence and Prolapse (WS Reynolds, Section Editor)

Hormone Replacement for Pelvic Floor Disorders

Overactive Bladder (U Lee and S Adelstein, Section Editors)

Treatment of Refractory Urinary Urgency, Frequency, and Incontinence in Pregnancy