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© The Canadian Journal of Urology™; 23(Supplement 1); February 2016
Nocturia: diagnosis and management for the
primary care physicians
Jack Barkin, MD
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
BARKIN J. Nocturia: diagnosis andmanagement for
theprimarycarephysicians.
CanJUrol
2016;23(Suppl1):
16-19.
Primary care physicians commonly see men or women
with nocturia (or nocturnal polyuria). Nocturia can have
a dramatic impact on a patient’s physical and emotional
quality of life, including work performance or ability
to function, because of the interrupted sleep patterns.
It has also been determined that the most important
sleep interval is the time from first falling asleep until
first awakening. Nocturia is one of the most common
and most bothersome symptoms of lower urinary tract
symptoms (LUTS). In a man, LUTS is most commonly
caused by benign prostatic obstruction (BPO) related to
the enlargement of the prostate. In a woman, the most
common cause of LUTS is overactive bladder (OAB).
This article first explores the different causes and types of
nocturia, then describes how to diagnose different types
of nocturia (including use of frequency-volume charts),
and last, discusses different approaches for managing
nocturia (including the use of desmopressin), depending
on the type and cause.
KeyWords:
nocturia, nocturnal polyuria, LUTS, BPH,
BPO, frequency-volume charts (FVC), desmopressin
Apatient work up helps clinicians determine the cause
of the symptoms as well as the degree of bother to the
patient. Patients generally only accept treatment for
symptoms that are bothering them.
1
Overactive bladder (OAB), which by definition
consists of symptoms of urgency and frequency with
or without urgency incontinence and nocturia, is
very common in men and women. In 2004, based on
earlier surveys, Corcos and colleagues,
2
estimated that
the prevalence of OAB in Canada was 14.8% in men
and 21.2% in women, whereas in 2008, Hershorn and
colleagues reported a somewhat lower estimate of
OAB prevalence: 13.1% in men and 14.7% in women.
3
16
Introduction
Lower urinary tract symptoms
Lower urinary tract symptoms (LUTS) in men and
women include frequency, urgency, hesitancy, urgency
incontinence, and nocturia. According to theAmerican
Urological Association (AUA) Symptom Index (SI),
symptoms fall into the urine storage (irritative), urine
voiding (obstructive), or post-micturition categories.
Address correspondence to Dr. Jack Barkin, Department of
Surgery, University of Toronto, 960 Lawrence Avenue West,
Suite 404, Toronto, ON M6A 3B5 Canada