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Nocturia in older men

Maturitas, Volume 71, Issue 1, 2012, pages 8 - 12

Abstract

Nocturia is a common and bothersome symptom that impacts on sleep-quality and quality of life. Nocturia often has a multi-factorial etiology which makes thorough assessment of the complaint indispensable.

This review summarizes the definition of nocturia, its epidemiology, clinical presentation, pathophysiology, diagnostics, and treatment options with special reference to older men.

Nocturia is defined as a nocturnal voiding frequency of two or more, based on impact on quality of life. It is very prevalent in older men. Apart from the negative effects of sleep-disruption, it may be a risk-factor for hip fractures and increased mortality. Most common causes are: nocturnal polyuria, 24-h polyuria, overactive bladder (sometimes due to BPH) and sleep disturbance. A clear understanding of the etiology in the individual patient is indispensable when addressing the various possible causes and co-morbidities. Most important tool for this is the frequency–volume chart, but also patient history, physical examination and serum analysis. For treatment, lifestyle adjustments are often helpful. Medical therapy with 5-alpha reductase inhibitors, alpha-blockers, a combination of the two, or anti-muscarinics, has a limited effect. Most important medical option is desmopressin (arginine vasopressin analogue); however, treatment with this drug is limited to men under 65 years mainly due to the risk of hyponatraemia.

Abbreviations: 5-ARI - 5-alpha reductase inhibitor, 15D HRQoL - 15 dimension health related quality of life, AUA-SS - American Urological Association symptom score, BPH - benign prostatic hyperplasia, DI - diabetes insipidus, DOX - doxazosin, FIN - finasteride, FVC - frequency–volume chart, HR - hazard ratio, ICS - International Continence Society, IPSS - international prostate symptom score, LUTS - lower urinary tract symptoms, NP - nocturnal polyuria, NVF - nocturnal voiding frequency, OAB - overactive bladder, OSA - obstructive sleep apnea, QoL - quality of life, REM - rapid eye movement, TER - terazosin, TURP - transurethral resection of the prostate.

Keywords: Nocturia, Quality of life, Overactive bladder, Nocturnal polyuria, Frequency–volume chart, Anti-diuretics.

Footnotes

Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands

lowast Corresponding author at: Department of Urology (HP: C04.236), University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 755 8079; fax: +31 30 2540532.