Elsevier

Urology

Volume 133, Supplement, November 2019, Pages 24-33
Urology

Supplement Article
Management of Nocturia and Nocturnal Polyuria

https://doi.org/10.1016/j.urology.2019.09.022Get rights and content
open access

Abstract

Nocturnal polyuria (NP), characterized by overproduction of urine at night (greater than 20%-33% of total 24-hour urine volume depending on age), is a major contributing factor in most nocturia cases. Nocturia can be caused by intake, urological, nephrological, hormonal, sleep, and cardiovascular factors. It is therefore important to accurately diagnose both the type of nocturia and the potentially associated medical conditions to determine appropriate treatment. Diagnostic tools, in addition to a thorough history and physical examination, include voiding/bladder diary analyses and questionnaires to diagnose nocturia type (NP, diminished nocturnal/global bladder capacity, global polyuria) and causative factors. Lifestyle modifications are the first intervention implemented for the management of nocturia and NP but, as symptoms progress, such measures may be insufficient, and pharmacotherapy may be initiated. While drugs for benign prostatic hyperplasia and overactive bladder have demonstrated statistically significant reductions in nocturnal voids, patients often fail to achieve a clinically meaningful response. Antidiuretic treatment is warranted for patients with nocturia due to NP because, in many patients, it treats the underlying cause (ie, insufficient secretion of antidiuretic hormone arginine vasopressin) that leads to overproduction of urine at night and has been shown to provide statistically significant reductions in nocturnal voids. Desmopressin, a synthetic analog of arginine vasopressin, is the only antidiuretic treatment indicated specifically for nocturia due to NP. Overall, the pathophysiology of NP is complex and differs from that of other types of nocturia. A multidisciplinary approach is necessary to effectively diagnose and manage this bothersome condition.

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Conflict of Interest: Jeffrey P. Weiss reports personal fees from Ferring and the Institute for Bladder and Prostate Research, outside the submitted work. Karel Everaert reports grants and other from Ferring during the conduct of the study; and grants from Ferring, grants from Astellas, grants from Medtronic, and other from P2Solutions outside the submitted work.

Disclosure Statement: Jeffrey P. Weiss and Karel Everaert received honoraria from IQVIA for their participation in a roundtable meeting supported by a grant from Ferring Pharmaceuticals.

This paper is part of a Supplement funded by a grant from Ferring Pharmaceuticals.