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Nocturia: state of the art and critical analysis of current assessment and treatment strategies

By Matthias Oelke, Erika Adler, Daniela Marschall‑Kehrel, Thomas R. W. Herrmann, Richard Berges

World Journal of Urology, Volume 32, Issue 5, October 2014; Pages 1109–1117

Editor's comments:
This editorial by Matthias Oelke and co-workers describes with in-depth analysis the state of the art on nocturia, particularly in relation to LUTS/BPH. Terminology, epidemiology, pathophysiology, assessment and treatment approaches of nocturia are all well investigated. The authors specifically describe trials conducted on LUTS/BPH in which nocturia has been shown to be a relevant and bothersome symptom. The authors observe that all trials only used assessment tools to evaluate the key parameters of LUTS/BPH, such as IPSS questionnaire, prostate volume, uroflowmetry, but they note a lack of specific instruments for the evaluation of nocturia and nocturnal polyuria. These instruments are represented by frequency–volume charts, measurements of hours of undisturbed sleep, and health-related QoL questionnaires. The particular value of the present editorial is represented by the inclusion of flow-charts to address the pathophysiology of nocturia, to well establish the diagnosis of the symptom, particularly addressing the frequency–volume chart and treatment of the various causes of nocturia. This editorial represents an important help for physicians and other healthcare providers to better cure individuals affected by nocturia. 

ABSTRACT

This editorial of the topic issue of the World Journal of Urology provides a state of the art on nocturia which includes descriptions of the terminology, epidemiology, health-related quality of life, medical and financial consequences, pathophysiology, assessment tools and treatment strategies of nocturia. This summary also includes a flowchart on the pathophysiology of nocturia with illustration of the various causes of reduced bladder capacity, increased fluid intake or increased diuresis; a flowchart with the key findings of frequency-volume charts to determine the underlying pathophysiology; and a flowchart on the treatment of the various causes of nocturia. The editorial critically discusses current assessment and treatment strategies in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and nocturia. The outcome of nocturia remains hidden in drug trials of patients with LUTS/BPH because nocturia-specific measures were not included. The authors recommend using frequency-volume charts, measurement of the hours of undisturbed sleep, and nocturia-specific quality of life questionnaires (e.g., ICIQ-N or N-Qol) in all future studies in patients with LUTS/BPH and nocturia.