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2017 ; 71
(11
): ä Nephropedia Template TP
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A practical approach to the management of nocturia
#MMPMID28984060
Oelke M
; De Wachter S
; Drake MJ
; Giannantoni A
; Kirby M
; Orme S
; Rees J
; van Kerrebroeck P
; Everaert K
Int J Clin Pract
2017[Nov]; 71
(11
): ä PMID28984060
show ga
AIM: To raise awareness on nocturia disease burden and to provide simplified
aetiologic evaluation and related treatment pathways. METHODS: A
multidisciplinary group of nocturia experts developed practical advice and
recommendations based on the best available evidence supplemented by their own
experiences. RESULTS: Nocturia is defined as the need to void ?1 time during the
sleeping period of the night. Clinically relevant nocturia (?2 voids per night)
affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged
70-80 years. Consequences include the following: lowered quality of life; falls
and fractures; reduced work productivity; depression; and increased mortality.
Nocturia-related hip fractures alone cost approximately ?1 billion in the EU and
$1.5 billion in the USA in 2014. The pathophysiology of nocturia is
multifactorial and typically related to polyuria (either global or nocturnal),
reduced bladder capacity or increased fluid intake. Accurate assessment is
predicated on frequency-volume charts combined with a detailed patient history,
medicine review and physical examination. Optimal treatment should focus on the
underlying cause(s), with lifestyle modifications (eg, reducing evening fluid
intake) being the first intervention. For patients with sustained bother, medical
therapies should be introduced; low-dose, gender-specific desmopressin has proven
effective in nocturia due to idiopathic nocturnal polyuria. The timing of
diuretics is an important consideration, and they should be taken mid-late
afternoon, dependent on the specific serum half-life. Patients not responding to
these basic treatments should be referred for specialist management. CONCLUSIONS:
The cause(s) of nocturia should be first evaluated in all patients. Afterwards,
the underlying pathophysiology should be treated specifically, alone with
lifestyle interventions or in combination with drugs or (prostate) surgery.
|Antidiuretic Agents/therapeutic use
[MESH]
|Deamino Arginine Vasopressin/therapeutic use
[MESH]
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