Nocturia

Abstract

Nocturia is a poorly understood symptom complex. It is seldom the result of obstructive lower urinary tract symptoms alone. Its association with multiple medical comorbidities and nocturnal polyuria explains the generally poor response to interventions aimed at improving outflow obstruction or lessening the impact of bladder instability. Nocturia is increasingly recognized as a surrogate marker for poor health and one that carries with it an increased risk of mortality. The management of nocturia needs to address not only the underlying medical conditions, but also the impact of nocturnal polyuria – the latter through anti-diuretic pharmacology or by manipulating the timing of an individual's diuresis to avoid periods of sleep. Those interventions which increase the time before the first wake to void in an individual with several episodes of nocturia should be deemed of greater clinical significance than those that simply reduce the total number of voided episodes. In this respect an understanding of the restorative function of deep slow-wave sleep should not be underestimated. A failure to understand the fundamental causes of nocturia frequently results in an ineffective polypharmacy which further impacts on the quality of life in a predominantly senescent population.