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Diagnosis and management of nocturia in current clinical practice: who are nocturia patients, and how do we treat them?

  • Siri Drangsholt 1,
  • Maria Juliana Arcila Ruiz 2,
  • Benoit Peyronnet 3,
  • Nirit Rosenblum 2,
  • Victor Nitti 2,
  • Benjamin Brucker 2
1 Department of Urology, New York University School of Medicine, New York, USA 2 Division of Female Pelvic Medicine and Reconstructive Surgery, New York University Langone Health, New York, USA 3 Department of Urology, Service D'Urologie, University of Rennes, Rennes, France





Objective

To characterize the current evaluation, and efficacy of treatments in patients with the primary complaint of nocturia.

Methods

A retrospective chart review was performed of new patient encounters seen in a tertiary urology practice from May 2010 to September 2016 with the primary diagnosis of nocturia (ICD-9 788.43 and ICD-10 R35.1).

Results

595 patients were identified. 403 met inclusion criteria. The median patient reported that nocturia episodes were 4 (1–20). 192 patients (48%) reported previous treatment for nocturia. After the index visit, a bladder diary (BD) was utilized in 50% of patients, with a 62% (n = 124) completion rate at follow-up visit. On BD analysis, the most common etiologies of nocturia were nocturnal polyuria 76% (n = 90) and overactive bladder in 21% (n = 26). Patient reported improvement with therapy after BD completion was 46% (n = 34), similar to patients without voiding diaries (43% improvement, n = 153). Anticholinergics and alpha blockers were the most commonly recommended drug, but no specific medication was associated with nocturia improvement. Oral desmopressin was used in 5% of patients.

Conclusion

Nocturia is a common condition and very commonly patients have sought treatment prior to presentation. Bladder diaries were recommended to half of the patients. Patient reported that improvement did not seem to correlate with completion of a bladder diary. Though most patients had NP the use of desmopressin was very low. Current treatments used in managing nocturia may lack efficacy.


Expert's summary

This article comes from the same authors as the previous article. In this article they aim at characterizing the current evaluation, and efficacy of treatments in patients with the primary complaint of nocturia.

They performed a retrospective chart review of new patient encounters seen in a tertiary urology practice in New York (USA) between May 2010 and September 2016 with the primary diagnosis of nocturia (ICD-9 788.43 and ICD-10 R35.1).

In total they identified 595 patients, of which 403 met the inclusion criteria. The median patient reported that nocturia episodes were 4 (1-20). Of the total group 192 patients (48%) reported previous treatment for nocturia. After the index visit, a bladder diary (BD) was utilized in 50% of patients, with a 62% (n = 124) completion rate at follow-up visit. On BD analysis, the most common aetiologies of nocturia were nocturnal polyuria 76% (n = 90) and overactive bladder in 21% (n = 26). Patient reported improvement with therapy after BD completion was 46% (n = 34), similar to patients without voiding diaries (43% improvement, n = 153). Anticholinergics and alpha blockers were the most commonly recommended drug, but no specific medication was associated with nocturia improvement. Oral desmopressin was used in 5% of patients.

Based on their results the authors reiterate that nocturia is a common condition and very commonly patients have sought treatment prior to presentation. The found that bladder diaries were recommended to only half of the patients, but that improvement as reported by the patients did not seem to correlate with completion of a bladder diary. Furthermore they found that although most patients had NP the use of desmopressin was very low.

As a general conclusion they state that current treatments used in managing nocturia may lack efficacy.

Expert's comment

The recent introduction on the US market of anti-diuretic drugs may change the current therapeutic approach of nocturia based on nocturnal polyuria and hence the clinical practice in patients with nocturia.

Tags: Desmopressin