Nocturia: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(89 intermediate revisions by 7 users not shown)
Line 1: Line 1:
'''For patient information click [[Nocturia (patient information)|here]]'''
__NOTOC__
 
{{SI}}
{{Infobox_Disease |
'''For patient information click [[Nocturia (patient information)|here]]'''  
  Name        = Nocturia |
  ICD10      = {{ICD10|R|35||r|30}} |
  ICD9        = {{ICD9|788.43}} |
}}
{{Search infobox}}
{{Search infobox}}
{{SCC}}
{{SCC}}; {{AE}} {{VSKP}} {{NN}}


==Overview==
==Overview==
'''Nocturia''' (derived from [[Latin language|Latin]] ''nox, night'', and [[Greek language|Greek]] ''[τα] ούρα, urine''), also called '''nycturia''' (Greek ''νυκτουρία''), is the need to get up during the night in order to urinate, thus interrupting sleep.  Its occurrence is more frequent in the elderly.  Nocturia could result simply from too much liquid intake before going to bed, or it could be a symptom of a larger problem, such as [[chronic renal failure]], [[urinary incontinence]], [[Interstitial Cystitis]], [[diabetes]], [[benign prostatic hyperplasia]], Ureteral Pelvic Junction Obstruction<ref>[http://www.emoryhealthcare.org/departments/urology/sub_menu/upj.html Ureteral Pelvic Junction Obstruction desc.]</ref> or [[prostate cancer]].
'''Nocturia''' (derived from [[Latin language|Latin]] ''nox, night'', and [[Greek language|Greek]] ''[τα] ούρα, urine''), also called '''nycturia''' (Greek ''νυκτουρία''), is the need to get up during the night in order to urinate, thus interrupting sleep.  Its occurrence is more frequent in the elderly.  Nocturia could result simply from too much liquid intake before going to bed, or it could be a symptom of a larger problem, such as [[chronic renal failure]], [[urinary incontinence]], [[Interstitial Cystitis]], [[diabetes]], [[benign prostatic hyperplasia]], [[Ureteropelvic junction obstruction]]<ref>[http://www.emoryhealthcare.org/departments/urology/sub_menu/upj.html Ureteral Pelvic Junction Obstruction desc.]</ref> or [[prostate cancer]].
 
==Historical Perspective==
*[[Nocturia]] was defined by International Continence Society (ICS) in 2002, as the need to wake up one or more times at nights to [[void]]. <ref name="pmid11857671">{{cite journal| author=Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U | display-authors=etal| title=The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. | journal=Neurourol Urodyn | year= 2002 | volume= 21 | issue= 2 | pages= 167-78 | pmid=11857671 | doi=10.1002/nau.10052 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11857671  }} </ref>
*Clinical definition of [[nocturia]] is awaking from sleep to urinate two or more that two times per night. <ref name="pmid24729150">{{cite journal| author=Van Kerrebroeck P, Andersson KE| title=Terminology, epidemiology, etiology, and pathophysiology of nocturia. | journal=Neurourol Urodyn | year= 2014 | volume= 33 Suppl 1 | issue=  | pages= S2-5 | pmid=24729150 | doi=10.1002/nau.22595 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24729150  }} </ref> <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
 
 
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
 
==Pathophysiology==
*It is thought that [[nocturia]] is caused by a number of factors, including<ref name="pmid21355977">{{cite journal| author=Gulur DM, Mevcha AM, Drake MJ| title=Nocturia as a manifestation of systemic disease. | journal=BJU Int | year= 2011 | volume= 107 | issue= 5 | pages= 702-713 | pmid=21355977 | doi=10.1111/j.1464-410X.2010.09763.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21355977  }} </ref><ref name="pmid23526404">{{cite journal| author=Weiss JP| title=Nocturia: focus on etiology and consequences. | journal=Rev Urol | year= 2012 | volume= 14 | issue= 3-4 | pages= 48-55 | pmid=23526404 | doi= | pmc=3602727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23526404  }} </ref> <ref name="pmid19226359">{{cite journal| author=Schneider T, de la Rosette JJ, Michel MC| title=Nocturia: a non-specific but important symptom of urological disease. | journal=Int J Urol | year= 2009 | volume= 16 | issue= 3 | pages= 249-56 | pmid=19226359 | doi=10.1111/j.1442-2042.2008.02246.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19226359  }} </ref>
**[[urological]] disorders
***abnormalities of [[bladder]] capacity
***[[prostate]] enlargement
**[[urine]] overproduction due to
*** depletion of [[third-space]] fluid in [[overload]] states following a recumbent position during sleep
***overproduction of [[atrial natriuretic peptide]] (ANP) caused by
****[[sleep apnea]]
****[[congestive heart failure]]
*** deficiency or dysfunction of [[antidiuretic hormone]] (ADH) or [[arginine vasopressin]] (AVP)
***[[medications]] such as [[diuretics]]
***[[behavioral]] factors such as high water intake at night
*AVP regulates [[urine]] production by [[antidiuretic]] effects in the collecting system in the [[kidneys]], resulted in<ref name="pmid23526404">{{cite journal| author=Weiss JP| title=Nocturia: focus on etiology and consequences. | journal=Rev Urol | year= 2012 | volume= 14 | issue= 3-4 | pages= 48-55 | pmid=23526404 | doi= | pmc=3602727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23526404  }} </ref>
**increasing water reabsorption
**decreasing [[urine volume]]
*AVP deficiency or AVP dysfunction leads to decreasing [[urine]] concentration, increasing [[urine volume]] and [[nocturia]]. <ref name="pmid23526404">{{cite journal| author=Weiss JP| title=Nocturia: focus on etiology and consequences. | journal=Rev Urol | year= 2012 | volume= 14 | issue= 3-4 | pages= 48-55 | pmid=23526404 | doi= | pmc=3602727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23526404  }} </ref><ref name="pmid19226359">{{cite journal| author=Schneider T, de la Rosette JJ, Michel MC| title=Nocturia: a non-specific but important symptom of urological disease. | journal=Int J Urol | year= 2009 | volume= 16 | issue= 3 | pages= 249-56 | pmid=19226359 | doi=10.1111/j.1442-2042.2008.02246.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19226359  }} </ref>
 
==Causes==
 
===Causes by Pathogenesis===


===Causes===
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | B01 | | | | | |B01=Causes of Nocturia}}
{{familytree | | | | | | | | | | B01 | | | | | |B01=Causes of Nocturia}}
Line 23: Line 55:
{{familytree/end}}
{{familytree/end}}


===Drug Side Effect===
====Causes Due to Hormonal Imbalance====
* [[Bicalutamide]]
 
* [[Progesterone]]
{| class="wikitable"
|-
! style="width: 30%;" | Global Polyuria
! style="width: 35%;" | Nocturnal Polyuria
! style="width: 35%;" | Sleep disorders
|-
| valign = top |
Defined as a 24-hour urine volume that exceeds 3 liters per day (or 40 mL per kg). The common causes of global polyuria are
*[[Diabetes mellitus]]- caused by low levels of [[Insulin]]
*[[Diabetes insipidus]]- caused by low levels of [[AVP]]
| valign = top |
Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. Nocturnal polyuria may be due to age-related changes in the secretion and action of [[arginine vasopressin]] [[(AVP)]]. There is a diurnal periodicity in AVP release in young, healthy subjects, with higher [[AVP]] plasma levels in the evening contributing to decreased nighttime urine output. The diurnal variation in [[AVP]] release is absent in many older people. Compared with the normal patients, nocturia patients have a nocturnal decrease in [[AVP]] level. Other causes of nocturnal polyuria include diseases such as
*[[congestive heart failure]],
*[[nephrotic syndrome]] and
*[[Hepatic failure]] or
*lifestyle patterns such as excessive nighttime drinking.
| valign = top |
Sleep disorders have been demonstrated to be a frequent cause of nocturia in men younger than 50 years and in women with symptoms of daytime overactive bladder syndrome. Primary sleep disorders may result in nocturia either because of hormonal changes related to sleep-disordered breathing or due to patient misperception of the reason for awakening due to the sleep disturbance but recall this as an awakening to void.
e.g.
*[[Sleep apnea|Obstructive sleep apnea]]([[OSA]])
*[[Restless leg syndrome]]
[[OSA]] may also cause nocturnal polyuria by release of [[atrial natriuretic peptide]] ([[ANP]]).
|}
 
====Causes Due to Vesical Problems====
{| class="wikitable"
|-
! style="width: 20%;" | Bladder storage disorder
|-
| valign = top |
Reduced bladder capacity or impaired bladder function results in low-volume voids. Most common causes of low-volume bladder voids are
*[[Overactive bladder]] (e.g. [[Urge incontinence]])
*[[Bladder outlet obstruction]] (e.g. [[BPH]])
|}
 
===Causes by Organ System===
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Heart failure]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Bicalutamide]], [[Cardiac glycosides]], [[Demeclocycline]], [[Diuretics]], [[Vitamin D|Excessive vitamin D intake]], [[Lithium]], [[Methoxyflurane]], [[Phenytoin]], [[Propoxyphene]], [[Tiagabine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|  [[Liver failure]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|  No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|  No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|  [[Interstitial cystitis]], [[UTI|Recurrent UTI]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"|  No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|  [[Detrusor hyperactivity]], [[Diabetes insipidus]], [[Neurogenic bladder ]], [[Parkinson disease]], [[Restless leg syndrome]], [[Urge incontinence]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Diabetes]], [[Obesity]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Prostate cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anxiety disorders]], [[Depression]], [[Obstructive sleep apnea]], [[Polydipsia|Primary polydipsia]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Chronic renal failure]], [[Diabetes insipidus]], [[Nephrotic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Benign prostatic hyperplasia]], [[Bladder outlet obstruction]], [[Detrusor hyperactivity]], [[Prostatitis|Granulomatous prostatitis]], [[Interstitial cystitis]], [[Neurogenic bladder]], [[Prostate cancer]], [[Ureteropelvic junction obstruction]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Paruresis|Learned voiding dysfunction]], [[Venous insufficiency]]
|-
|}
 
===Causes in Alphabetical Order===
{{columns-list|
*[[Anxiety disorders]]
*[[Benign prostatic hyperplasia]]
*[[Bicalutamide]]
*[[Bladder outlet obstruction]]
*[[Cardiac glycosides]]
*[[Chronic renal failure]]
*[[Demeclocycline]]
*[[Depression]]
*[[Detrusor hyperactivity]]
*[[Diabetes]]
*[[Diabetes insipidus]]
*[[Diuretics]]
*[[Vitamin D|Excessive vitamin D intake]]
*[[Prostatitis|Granulomatous prostatitis]]
*[[Heart failure]]
*[[Interstitial cystitis]]
*[[Learned voiding dysfunction]]
*[[Lithium]]
*[[Liver failure]]
*[[Methoxyflurane]]
*[[Nephrotic syndrome]]
*[[Neurogenic bladder ]]
*[[Obesity]]
*[[Obstructive sleep apnea ]]
*[[Parkinson disease]]
*[[Phenytoin]]
*[[Primary hyperaldosteronism]]
*[[Propoxyphene]]
*[[Polydipsia|Primary polydipsia]]
*[[Prostate cancer]]
*[[UTI|Recurrent UTI]]
*[[Restless leg syndrome]]
*[[Tiagabine]]
*[[Tiagabine]]
*[[Ureteropelvic junction obstruction]]
*[[Urge incontinence]]
*[[Venous insufficiency]]
}}
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
==Epidemiology and Demographics==
*The prevalence of [[nocturia]] ≥ 1 voids is approximately 69000 per 100,000 [[men]] aged ≥ 40 years and 76000 per 100,000 [[women]] aged ≥ 40 years in the United States, United Kingdom, and Sweden. <ref name="pmid19302497">{{cite journal| author=Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS | display-authors=etal| title=The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. | journal=BJU Int | year= 2009 | volume= 103 Suppl 3 | issue=  | pages= 4-11 | pmid=19302497 | doi=10.1111/j.1464-410X.2009.08371.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19302497  }} </ref> <ref name="pmid23526404">{{cite journal| author=Weiss JP| title=Nocturia: focus on etiology and consequences. | journal=Rev Urol | year= 2012 | volume= 14 | issue= 3-4 | pages= 48-55 | pmid=23526404 | doi= | pmc=3602727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23526404  }} </ref>
*The prevalence of [[nocturia]] ≥ 2 voids in population aged 20-30 years is approximately 4000 to 18000 per 100,000 women and 2000 to 17000 per 100,000 men. <ref name="pmid20620395">{{cite journal| author=Bosch JL, Weiss JP| title=The prevalence and causes of nocturia. | journal=J Urol | year= 2010 | volume= 184 | issue= 2 | pages= 440-6 | pmid=20620395 | doi=10.1016/j.juro.2010.04.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620395  }} </ref>
*The prevalence of [[nocturia]] ≥ 2 voids in population aged 70-80 years is 28000 to 62000 per 100,000 women and 29000 to 59000 per 100,000 men. <ref name="pmid20620395">{{cite journal| author=Bosch JL, Weiss JP| title=The prevalence and causes of nocturia. | journal=J Urol | year= 2010 | volume= 184 | issue= 2 | pages= 440-6 | pmid=20620395 | doi=10.1016/j.juro.2010.04.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620395  }} </ref>
* The prevalence of [[nocturia]] ≥ 2 voids in in Canada, Germany, Italy, Sweden, and the United Kingdom is 13000 to 17000 per 100,000 individuals aged < 40 years and 20000 to 21000 per 100,000 middle-aged populations and 35000 to 36000 per 100,000 individuals aged ≥ 60 years. <ref name="pmid17049716">{{cite journal| author=Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S | display-authors=etal| title=Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. | journal=Eur Urol | year= 2006 | volume= 50 | issue= 6 | pages= 1306-14; discussion 1314-5 | pmid=17049716 | doi=10.1016/j.eururo.2006.09.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17049716  }} </ref>
*The incidence of [[nocturia]] increases with age. <ref name="pmid20620395">{{cite journal| author=Bosch JL, Weiss JP| title=The prevalence and causes of nocturia. | journal=J Urol | year= 2010 | volume= 184 | issue= 2 | pages= 440-6 | pmid=20620395 | doi=10.1016/j.juro.2010.04.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620395  }} </ref>
*[[Nocturia]] can affect younger people as 1 from 5 or 6 younger population wake up at least two times per night to void. <ref name="pmid20620395">{{cite journal| author=Bosch JL, Weiss JP| title=The prevalence and causes of nocturia. | journal=J Urol | year= 2010 | volume= 184 | issue= 2 | pages= 440-6 | pmid=20620395 | doi=10.1016/j.juro.2010.04.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620395  }} </ref> <ref name="pmid17049716">{{cite journal| author=Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S | display-authors=etal| title=Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. | journal=Eur Urol | year= 2006 | volume= 50 | issue= 6 | pages= 1306-14; discussion 1314-5 | pmid=17049716 | doi=10.1016/j.eururo.2006.09.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17049716  }} </ref>
* [[non-Hispanic black]] men are more likely to develop [[nocturia]]. <ref name="pmid21251675">{{cite journal| author=Markland AD, Vaughan CP, Johnson TM, Goode PS, Redden DT, Burgio KL| title=Prevalence of nocturia in United States men: results from the National Health and Nutrition Examination Survey. | journal=J Urol | year= 2011 | volume= 185 | issue= 3 | pages= 998-1002 | pmid=21251675 | doi=10.1016/j.juro.2010.10.083 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21251675  }} </ref> <ref name="pmid23526404">{{cite journal| author=Weiss JP| title=Nocturia: focus on etiology and consequences. | journal=Rev Urol | year= 2012 | volume= 14 | issue= 3-4 | pages= 48-55 | pmid=23526404 | doi= | pmc=3602727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23526404  }} </ref>
*[[nocturia]] affects men and women equally. However, [[nocturia]] incidence are more in young women than young men, and also old men are more likely to develop [[nocturia]] than old women. <ref name="pmid16086673">{{cite journal| author=Hunskaar S| title=Epidemiology of nocturia. | journal=BJU Int | year= 2005 | volume= 96 Suppl 1 | issue=  | pages= 4-7 | pmid=16086673 | doi=10.1111/j.1464-410X.2005.05650.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16086673  }} </ref>
==Risk Factors==
*Common risk factors in the development of [[nocturia]] include<ref name="pmid26351086">{{cite journal| author=Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z| title=Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. | journal=Int J Clin Pract | year= 2015 | volume= 69 | issue= 12 | pages= 1508-16 | pmid=26351086 | doi=10.1111/ijcp.12727 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26351086  }} </ref> <ref name="pmid15147543">{{cite journal| author=Yoshimura K, Terada N, Matsui Y, Terai A, Kinukawa N, Arai Y| title=Prevalence of and risk factors for nocturia: Analysis of a health screening program. | journal=Int J Urol | year= 2004 | volume= 11 | issue= 5 | pages= 282-7 | pmid=15147543 | doi=10.1111/j.1442-2042.2004.00791.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15147543  }} </ref><ref name="pmid15935026">{{cite journal| author=Johnson TM, Sattin RW, Parmelee P, Fultz NH, Ouslander JG| title=Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults. | journal=J Am Geriatr Soc | year= 2005 | volume= 53 | issue= 6 | pages= 1011-6 | pmid=15935026 | doi=10.1111/j.1532-5415.2005.53321.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15935026  }} </ref>
**[[aging]]
**Hispanic and Black race
**history of [[nocturia]] during childhood
**history of pre-existing conditions
***[[Diabetes mellitus]]
***[[Diabetes insipidus]]
***[[Hypertension]]
***[[Arthritis]]
*** [[Airway disease]] such as [[Asthma]]
**history of psychological disease
***[[Depression]]
***[[Anxiety disorders]]
**history of [[diuretic]] intake
* Potent risk factors in the development of [[nocturia]] in men include<ref name="pmid26351086">{{cite journal| author=Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z| title=Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. | journal=Int J Clin Pract | year= 2015 | volume= 69 | issue= 12 | pages= 1508-16 | pmid=26351086 | doi=10.1111/ijcp.12727 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26351086  }} </ref><ref name="pmid15935026">{{cite journal| author=Johnson TM, Sattin RW, Parmelee P, Fultz NH, Ouslander JG| title=Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults. | journal=J Am Geriatr Soc | year= 2005 | volume= 53 | issue= 6 | pages= 1011-6 | pmid=15935026 | doi=10.1111/j.1532-5415.2005.53321.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15935026  }} </ref>
** [[prostatitis]]
** [[benign prostatic hyperplasia]]
** [[prostate cancer]]
* Potent risk factors in the development of [[nocturia]] in women include<ref name="pmid26351086">{{cite journal| author=Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z| title=Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. | journal=Int J Clin Pract | year= 2015 | volume= 69 | issue= 12 | pages= 1508-16 | pmid=26351086 | doi=10.1111/ijcp.12727 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26351086  }} </ref>
**high [[BMI]]
** [[Heart disease]]
**[[Inflammatory bowel disease]]
**[[Uterine prolapse]]
**[[Hysterectomy]]
**[[Menopause]]
**recurrent [[UTI]]
==Screening==
There is insufficient evidence to recommend routine screening for [[nocturia]].
==Natural History, Complications, and Prognosis==
*Common complications of [[nocturia]] include<ref name="pmid20620395">{{cite journal| author=Bosch JL, Weiss JP| title=The prevalence and causes of nocturia. | journal=J Urol | year= 2010 | volume= 184 | issue= 2 | pages= 440-6 | pmid=20620395 | doi=10.1016/j.juro.2010.04.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620395  }} </ref><ref name="pmid19302497">{{cite journal| author=Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS | display-authors=etal| title=The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. | journal=BJU Int | year= 2009 | volume= 103 Suppl 3 | issue=  | pages= 4-11 | pmid=19302497 | doi=10.1111/j.1464-410X.2009.08371.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19302497  }} </ref><ref name="pmid10869627">{{cite journal| author=Schatzl G, Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S| title=Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project. | journal=Urology | year= 2000 | volume= 56 | issue= 1 | pages= 71-5 | pmid=10869627 | doi=10.1016/s0090-4295(00)00603-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10869627  }} </ref><ref name="pmid18703381">{{cite journal| author=Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK| title=Nocturia and disturbed sleep in the elderly. | journal=Sleep Med | year= 2009 | volume= 10 | issue= 5 | pages= 540-8 | pmid=18703381 | doi=10.1016/j.sleep.2008.04.002 | pmc=2735085 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703381  }} </ref><ref name="pmid20727545">{{cite journal| author=Nakagawa H, Niu K, Hozawa A, Ikeda Y, Kaiho Y, Ohmori-Matsuda K | display-authors=etal| title=Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. | journal=J Urol | year= 2010 | volume= 184 | issue= 4 | pages= 1413-8 | pmid=20727545 | doi=10.1016/j.juro.2010.05.093 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20727545  }} </ref><ref name="pmid23526404">{{cite journal| author=Weiss JP| title=Nocturia: focus on etiology and consequences. | journal=Rev Urol | year= 2012 | volume= 14 | issue= 3-4 | pages= 48-55 | pmid=23526404 | doi= | pmc=3602727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23526404  }} </ref><ref name="pmid22425119">{{cite journal| author=van Doorn B, Kok ET, Blanker MH, Westers P, Bosch JL| title=Mortality in older men with nocturia. A 15-year followup of the Krimpen study. | journal=J Urol | year= 2012 | volume= 187 | issue= 5 | pages= 1727-31 | pmid=22425119 | doi=10.1016/j.juro.2011.12.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22425119  }} </ref>
**[[Sleep disorders]]
** [[Depression]]
** [[anxiety disorders]]
**lower [[quality of life]]
** increased risk of falling and [[bone]] [[fracture]]
**increased [[mortality]]
==Diagnosis==
===Diagnostic Study of Choice===
*The diagnosis of [[nocturia]] is based on the clinical history defined by International Continence Society (ICS) in 2002, which includes wake up at night ≥1 times to void. <ref name="pmid11857672">{{cite journal| author=van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S | display-authors=etal| title=The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. | journal=Neurourol Urodyn | year= 2002 | volume= 21 | issue= 2 | pages= 179-83 | pmid=11857672 | doi=10.1002/nau.10053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11857672  }} </ref>
*According to new revised definition in 2017 , nocturia is to wake up to void during the sleep period. <ref name="pmid30644584">{{cite journal| author=Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V | display-authors=etal| title=International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function. | journal=Neurourol Urodyn | year= 2019 | volume= 38 | issue= 2 | pages= 499-508 | pmid=30644584 | doi=10.1002/nau.23917 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30644584  }} </ref>
*Bladder diary should be asked from the patients, including <ref name="pmid29410891">{{cite journal| author=Miotła P, Dobruch J, Lipiński M, Drewa T, Kołodziej A, Barcz E | display-authors=etal| title=Diagnostic and therapeutic recommendations for patients with nocturia. | journal=Cent European J Urol | year= 2017 | volume= 70 | issue= 4 | pages= 388-393 | pmid=29410891 | doi=10.5173/ceju.2017.1563 | pmc=5791408 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29410891  }} </ref>
**the amount of water intake
**the time of water intake
**time and volume of urination
***the number of urinations during the day
***the number of nocturia (urination during the sleep),
***the number of urinations and the amount of urine production during the day
* Frequency- volume charts can be diagnostic for [[nocturia]]. <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
===History and Symptoms===
*The most common symptoms of [[nocturia]] include passing urine, [[urgency]] and [[frequency]] at nights. <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
*History of fluid, [[alcohol]] and [[caffeine]] intake, [[urinary]] symptoms, [[medications]] , sleep disorders should be asked from the patients. <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
** Some [[medications]] that cause [[nocturia]] include [[diuretics]], [[amlodipine]] and [[nifedipine]] should be discontinued.
===Physical Examination===
*physical examination should include <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
**Checking [[Blood pressure]]
**[[digital rectal examination]] of the [[prostate]] in men and pelvic examination in women
**checking [[edema]] of the lower limbs
**checking [[genitalia]] diseases (phimosis, meatal stenosis or cancer)
**abdominal examination especially [[bladder]] to assess [[urinary retention]]
**calculating BMI and/or waist circumference
**filling the chart of Frequency-volume for at least 3 days
===Laboratory Findings===
*Laboratory tests that should be helpful for the diagnosis of [[nocturia]] include <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
**[[urine analysis]] with [[urine culture]] to rule out [[urinary tract infection]]
**serum [[electrolytes]]
**[[renal]] function tests such as [[BUN]], [[creatinine]], [[GFR]]
**serum glucose level and HbA1c to rule out [[diabetes mellitus]]
**[[lipid]] profile
**PSA level to rule out [[prostate cancer]] and [[BPH]]
===Electrocardiogram===
There are no ECG findings associated with [[nocturia]].
===X-ray===
There are no x-ray findings associated with [[nocturia]].
===Ultrasound===
*ultrasound may be helpful in the diagnosis of [[nocturia]] associated conditions. Ultrasound can measure [[postvoid residual volume]] and [[bladder]] wall thickness. <ref name="urlNocturia: Causes, Treatments, and Prevention">{{cite web |url=https://www.healthline.com/health/urination-excessive-at-night#prevention |title=Nocturia: Causes, Treatments, and Prevention |format= |work= |accessdate=}}</ref><ref name="pmid20127835">{{cite journal| author=Panayi DC, Tekkis P, Fernando R, Hendricken C, Khullar V| title=Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome. | journal=Neurourol Urodyn | year= 2010 | volume= 29 | issue= 7 | pages= 1295-8 | pmid=20127835 | doi=10.1002/nau.20871 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20127835  }} </ref>
===CT scan===
*There are no CT scan findings associated with [[nocturia]]. However, a CT scan may be helpful in the diagnosis of [[bladder]], [[prostate]] and [[urinary tracts]] abnormalities.<ref name="urlNocturia: Causes, Treatments, and Prevention">{{cite web |url=https://www.healthline.com/health/urination-excessive-at-night#prevention |title=Nocturia: Causes, Treatments, and Prevention |format= |work= |accessdate=}}</ref>
===MRI===
There are no MRI findings associated with [[nocturia]].
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===
*[[Cystoscopy]] may be helpful in the diagnosis of [[bladder]] abnormalities that cause [[nocturia]]. <ref name="urlNocturia: Causes, Treatments, and Prevention">{{cite web |url=https://www.healthline.com/health/urination-excessive-at-night#prevention |title=Nocturia: Causes, Treatments, and Prevention |format= |work= |accessdate=}}</ref>
==Treatment==
===Medical Therapy===
=== Treatment===
* Treatment options for [[nocturia]] depend on the underlying causes.
*Behavioral modification includes <ref name="pmid29410891">{{cite journal| author=Miotła P, Dobruch J, Lipiński M, Drewa T, Kołodziej A, Barcz E | display-authors=etal| title=Diagnostic and therapeutic recommendations for patients with nocturia. | journal=Cent European J Urol | year= 2017 | volume= 70 | issue= 4 | pages= 388-393 | pmid=29410891 | doi=10.5173/ceju.2017.1563 | pmc=5791408 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29410891  }} </ref> <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref>
** limiting fluid intake in the evening
**avoiding alcohol, coffee and tea
**treating underlying conditions such as chronic [[constipation]], [[diabetes mellitus]], [[diabetes insipidus]]
**elevation of the lower limbs in the evening
**avoiding [[diuretics]] intake in the evening and night
**[[physical exercise]]
* Pharmacologic medical therapies for [[nocturia]] include
**[[desmopressin]] ([[arginine]] [[vasopressin]]) <ref name="pmid29410891">{{cite journal| author=Miotła P, Dobruch J, Lipiński M, Drewa T, Kołodziej A, Barcz E | display-authors=etal| title=Diagnostic and therapeutic recommendations for patients with nocturia. | journal=Cent European J Urol | year= 2017 | volume= 70 | issue= 4 | pages= 388-393 | pmid=29410891 | doi=10.5173/ceju.2017.1563 | pmc=5791408 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29410891  }} </ref>
***It decreases urine volume through [[vasopressin]] V2 receptors, which leads to increase water reabsorption in [[renal tubules]].
*** It is the preferred drug for the treatment of [[nocturia]] due to nocturnal polyuria according to the European Association of Urology (EAU) recommendation. <ref name="pmid23541338">{{cite journal| author=Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC | display-authors=etal| title=EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. | journal=Eur Urol | year= 2013 | volume= 64 | issue= 1 | pages= 118-40 | pmid=23541338 | doi=10.1016/j.eururo.2013.03.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23541338  }} </ref>
** α-blockers
** antimuscarinics
**phosphodiesterase type 5 inhibitors
**Botulinum toxin
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
===Primary Prevention===
*Effective measures for the primary prevention of [[nocturia]] include [[lifestyle]] modifications such as <ref name="pmid28984060">{{cite journal| author=Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S | display-authors=etal| title=A practical approach to the management of nocturia. | journal=Int J Clin Pract | year= 2017 | volume= 71 | issue= 11 | pages=  | pmid=28984060 | doi=10.1111/ijcp.13027 | pmc=5698733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28984060  }} </ref><ref name="urlNocturia: Causes, Treatments, and Prevention">{{cite web |url=https://www.healthline.com/health/urination-excessive-at-night#prevention |title=Nocturia: Causes, Treatments, and Prevention |format= |work= |accessdate=}}</ref>
**reducing intake of [[fluid]], [[caffeine]], [[alcohol]], [[diuretics]] in the evening and night
**less [[salt]] intake
**take naps in the afternoon
**[[weight loss]] in obese and overweight individuals
**[[urination]] before going to bed
**using compression stocks or elevating legs to reduce edema
===Secondary Prevention===
There are no established measures for the secondary prevention of [[nocturia]].


==References==
==References==
Line 34: Line 437:
* [[Polyuria]]
* [[Polyuria]]
* [[Enuresis]]
* [[Enuresis]]
{{Symptoms and signs}}
{{SleepSeries2}}


[[Category:Urology]]
[[Category:Urology]]
Line 44: Line 442:
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Geriatrics]]
[[Category:Geriatrics]]
[[pl:Nykturia]]
{{WH}}
{{WikiDoc Sources}}

Latest revision as of 22:39, 5 April 2021

WikiDoc Resources for Nocturia

Articles

Most recent articles on Nocturia

Most cited articles on Nocturia

Review articles on Nocturia

Articles on Nocturia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Nocturia

Images of Nocturia

Photos of Nocturia

Podcasts & MP3s on Nocturia

Videos on Nocturia

Evidence Based Medicine

Cochrane Collaboration on Nocturia

Bandolier on Nocturia

TRIP on Nocturia

Clinical Trials

Ongoing Trials on Nocturia at Clinical Trials.gov

Trial results on Nocturia

Clinical Trials on Nocturia at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Nocturia

NICE Guidance on Nocturia

NHS PRODIGY Guidance

FDA on Nocturia

CDC on Nocturia

Books

Books on Nocturia

News

Nocturia in the news

Be alerted to news on Nocturia

News trends on Nocturia

Commentary

Blogs on Nocturia

Definitions

Definitions of Nocturia

Patient Resources / Community

Patient resources on Nocturia

Discussion groups on Nocturia

Patient Handouts on Nocturia

Directions to Hospitals Treating Nocturia

Risk calculators and risk factors for Nocturia

Healthcare Provider Resources

Symptoms of Nocturia

Causes & Risk Factors for Nocturia

Diagnostic studies for Nocturia

Treatment of Nocturia

Continuing Medical Education (CME)

CME Programs on Nocturia

International

Nocturia en Espanol

Nocturia en Francais

Business

Nocturia in the Marketplace

Patents on Nocturia

Experimental / Informatics

List of terms related to Nocturia

For patient information click here Template:Search infobox Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1] Nasrin Nikravangolsefid, MD-MPH [2]

Overview

Nocturia (derived from Latin nox, night, and Greek [τα] ούρα, urine), also called nycturia (Greek νυκτουρία), is the need to get up during the night in order to urinate, thus interrupting sleep. Its occurrence is more frequent in the elderly. Nocturia could result simply from too much liquid intake before going to bed, or it could be a symptom of a larger problem, such as chronic renal failure, urinary incontinence, Interstitial Cystitis, diabetes, benign prostatic hyperplasia, Ureteropelvic junction obstruction[1] or prostate cancer.

Historical Perspective

  • Nocturia was defined by International Continence Society (ICS) in 2002, as the need to wake up one or more times at nights to void. [2]
  • Clinical definition of nocturia is awaking from sleep to urinate two or more that two times per night. [3] [4]


The association between [important risk factor/cause] and [disease name] was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].

In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

There have been several outbreaks of [disease name], including -----.

In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].

Pathophysiology

Causes

Causes by Pathogenesis

 
 
 
 
 
 
 
 
 
Causes of Nocturia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Due to Hormonal imbalance
 
 
 
 
 
 
 
 
Due to Vesical problems
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Global Polyuria
 
Nocturanl Polyuria
 
Sleep disorders
 
 
 
 
Bladder storage disorders

Causes Due to Hormonal Imbalance

Global Polyuria Nocturnal Polyuria Sleep disorders

Defined as a 24-hour urine volume that exceeds 3 liters per day (or 40 mL per kg). The common causes of global polyuria are

Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. Nocturnal polyuria may be due to age-related changes in the secretion and action of arginine vasopressin (AVP). There is a diurnal periodicity in AVP release in young, healthy subjects, with higher AVP plasma levels in the evening contributing to decreased nighttime urine output. The diurnal variation in AVP release is absent in many older people. Compared with the normal patients, nocturia patients have a nocturnal decrease in AVP level. Other causes of nocturnal polyuria include diseases such as

Sleep disorders have been demonstrated to be a frequent cause of nocturia in men younger than 50 years and in women with symptoms of daytime overactive bladder syndrome. Primary sleep disorders may result in nocturia either because of hormonal changes related to sleep-disordered breathing or due to patient misperception of the reason for awakening due to the sleep disturbance but recall this as an awakening to void. e.g.

OSA may also cause nocturnal polyuria by release of atrial natriuretic peptide (ANP).

Causes Due to Vesical Problems

Bladder storage disorder

Reduced bladder capacity or impaired bladder function results in low-volume voids. Most common causes of low-volume bladder voids are

Causes by Organ System

Cardiovascular Heart failure
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Bicalutamide, Cardiac glycosides, Demeclocycline, Diuretics, Excessive vitamin D intake, Lithium, Methoxyflurane, Phenytoin, Propoxyphene, Tiagabine
Ear Nose Throat No underlying causes
Endocrine Liver failure
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Interstitial cystitis, Recurrent UTI
Musculoskeletal/Orthopedic No underlying causes
Neurologic Detrusor hyperactivity, Diabetes insipidus, Neurogenic bladder , Parkinson disease, Restless leg syndrome, Urge incontinence
Nutritional/Metabolic Diabetes, Obesity
Obstetric/Gynecologic No underlying causes
Oncologic Prostate cancer
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anxiety disorders, Depression, Obstructive sleep apnea, Primary polydipsia
Pulmonary No underlying causes
Renal/Electrolyte Chronic renal failure, Diabetes insipidus, Nephrotic syndrome
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic Benign prostatic hyperplasia, Bladder outlet obstruction, Detrusor hyperactivity, Granulomatous prostatitis, Interstitial cystitis, Neurogenic bladder, Prostate cancer, Ureteropelvic junction obstruction
Miscellaneous Learned voiding dysfunction, Venous insufficiency

Causes in Alphabetical Order

Differentiating ((Page name)) from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

  • The prevalence of nocturia ≥ 1 voids is approximately 69000 per 100,000 men aged ≥ 40 years and 76000 per 100,000 women aged ≥ 40 years in the United States, United Kingdom, and Sweden. [8] [6]
  • The prevalence of nocturia ≥ 2 voids in population aged 20-30 years is approximately 4000 to 18000 per 100,000 women and 2000 to 17000 per 100,000 men. [9]
  • The prevalence of nocturia ≥ 2 voids in population aged 70-80 years is 28000 to 62000 per 100,000 women and 29000 to 59000 per 100,000 men. [9]
  • The prevalence of nocturia ≥ 2 voids in in Canada, Germany, Italy, Sweden, and the United Kingdom is 13000 to 17000 per 100,000 individuals aged < 40 years and 20000 to 21000 per 100,000 middle-aged populations and 35000 to 36000 per 100,000 individuals aged ≥ 60 years. [10]

Risk Factors

Screening

There is insufficient evidence to recommend routine screening for nocturia.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

  • The diagnosis of nocturia is based on the clinical history defined by International Continence Society (ICS) in 2002, which includes wake up at night ≥1 times to void. [20]
  • According to new revised definition in 2017 , nocturia is to wake up to void during the sleep period. [21]
  • Bladder diary should be asked from the patients, including [22]
    • the amount of water intake
    • the time of water intake
    • time and volume of urination
      • the number of urinations during the day
      • the number of nocturia (urination during the sleep),
      • the number of urinations and the amount of urine production during the day
  • Frequency- volume charts can be diagnostic for nocturia. [4]

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with nocturia.

X-ray

There are no x-ray findings associated with nocturia.

Ultrasound

CT scan

MRI

There are no MRI findings associated with nocturia.

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

Treatment

Medical Therapy

Treatment

  • Treatment options for nocturia depend on the underlying causes.
  • Behavioral modification includes [22] [4]
  • Pharmacologic medical therapies for nocturia include
    • desmopressin (arginine vasopressin) [22]
      • It decreases urine volume through vasopressin V2 receptors, which leads to increase water reabsorption in renal tubules.
      • It is the preferred drug for the treatment of nocturia due to nocturnal polyuria according to the European Association of Urology (EAU) recommendation. [25]
    • α-blockers
    • antimuscarinics
    • phosphodiesterase type 5 inhibitors
    • Botulinum toxin


Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

Secondary Prevention

There are no established measures for the secondary prevention of nocturia.

References

  1. ↑ Ureteral Pelvic Junction Obstruction desc.
  2. ↑ Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U; et al. (2002). "The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society". Neurourol Urodyn. 21 (2): 167–78. doi:10.1002/nau.10052. PMID 11857671.
  3. ↑ Van Kerrebroeck P, Andersson KE (2014). "Terminology, epidemiology, etiology, and pathophysiology of nocturia". Neurourol Urodyn. 33 Suppl 1: S2–5. doi:10.1002/nau.22595. PMID 24729150.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S; et al. (2017). "A practical approach to the management of nocturia". Int J Clin Pract. 71 (11). doi:10.1111/ijcp.13027. PMC 5698733. PMID 28984060.
  5. ↑ Gulur DM, Mevcha AM, Drake MJ (2011). "Nocturia as a manifestation of systemic disease". BJU Int. 107 (5): 702–713. doi:10.1111/j.1464-410X.2010.09763.x. PMID 21355977.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Weiss JP (2012). "Nocturia: focus on etiology and consequences". Rev Urol. 14 (3–4): 48–55. PMC 3602727. PMID 23526404.
  7. ↑ 7.0 7.1 Schneider T, de la Rosette JJ, Michel MC (2009). "Nocturia: a non-specific but important symptom of urological disease". Int J Urol. 16 (3): 249–56. doi:10.1111/j.1442-2042.2008.02246.x. PMID 19226359.
  8. ↑ 8.0 8.1 Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS; et al. (2009). "The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS". BJU Int. 103 Suppl 3: 4–11. doi:10.1111/j.1464-410X.2009.08371.x. PMID 19302497.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 Bosch JL, Weiss JP (2010). "The prevalence and causes of nocturia". J Urol. 184 (2): 440–6. doi:10.1016/j.juro.2010.04.011. PMID 20620395.
  10. ↑ 10.0 10.1 Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S; et al. (2006). "Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study". Eur Urol. 50 (6): 1306–14, discussion 1314-5. doi:10.1016/j.eururo.2006.09.019. PMID 17049716.
  11. ↑ Markland AD, Vaughan CP, Johnson TM, Goode PS, Redden DT, Burgio KL (2011). "Prevalence of nocturia in United States men: results from the National Health and Nutrition Examination Survey". J Urol. 185 (3): 998–1002. doi:10.1016/j.juro.2010.10.083. PMID 21251675.
  12. ↑ Hunskaar S (2005). "Epidemiology of nocturia". BJU Int. 96 Suppl 1: 4–7. doi:10.1111/j.1464-410X.2005.05650.x. PMID 16086673.
  13. ↑ 13.0 13.1 13.2 Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z (2015). "Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study". Int J Clin Pract. 69 (12): 1508–16. doi:10.1111/ijcp.12727. PMID 26351086.
  14. ↑ Yoshimura K, Terada N, Matsui Y, Terai A, Kinukawa N, Arai Y (2004). "Prevalence of and risk factors for nocturia: Analysis of a health screening program". Int J Urol. 11 (5): 282–7. doi:10.1111/j.1442-2042.2004.00791.x. PMID 15147543.
  15. ↑ 15.0 15.1 Johnson TM, Sattin RW, Parmelee P, Fultz NH, Ouslander JG (2005). "Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults". J Am Geriatr Soc. 53 (6): 1011–6. doi:10.1111/j.1532-5415.2005.53321.x. PMID 15935026.
  16. ↑ Schatzl G, Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S (2000). "Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project". Urology. 56 (1): 71–5. doi:10.1016/s0090-4295(00)00603-8. PMID 10869627.
  17. ↑ Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK (2009). "Nocturia and disturbed sleep in the elderly". Sleep Med. 10 (5): 540–8. doi:10.1016/j.sleep.2008.04.002. PMC 2735085. PMID 18703381.
  18. ↑ Nakagawa H, Niu K, Hozawa A, Ikeda Y, Kaiho Y, Ohmori-Matsuda K; et al. (2010). "Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study". J Urol. 184 (4): 1413–8. doi:10.1016/j.juro.2010.05.093. PMID 20727545.
  19. ↑ van Doorn B, Kok ET, Blanker MH, Westers P, Bosch JL (2012). "Mortality in older men with nocturia. A 15-year followup of the Krimpen study". J Urol. 187 (5): 1727–31. doi:10.1016/j.juro.2011.12.078. PMID 22425119.
  20. ↑ van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S; et al. (2002). "The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society". Neurourol Urodyn. 21 (2): 179–83. doi:10.1002/nau.10053. PMID 11857672.
  21. ↑ Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V; et al. (2019). "International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function". Neurourol Urodyn. 38 (2): 499–508. doi:10.1002/nau.23917. PMID 30644584.
  22. ↑ 22.0 22.1 22.2 Miotła P, Dobruch J, Lipiński M, Drewa T, Kołodziej A, Barcz E; et al. (2017). "Diagnostic and therapeutic recommendations for patients with nocturia". Cent European J Urol. 70 (4): 388–393. doi:10.5173/ceju.2017.1563. PMC 5791408. PMID 29410891.
  23. ↑ 23.0 23.1 23.2 23.3 "Nocturia: Causes, Treatments, and Prevention".
  24. ↑ Panayi DC, Tekkis P, Fernando R, Hendricken C, Khullar V (2010). "Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome". Neurourol Urodyn. 29 (7): 1295–8. doi:10.1002/nau.20871. PMID 20127835.
  25. ↑ Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC; et al. (2013). "EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction". Eur Urol. 64 (1): 118–40. doi:10.1016/j.eururo.2013.03.004. PMID 23541338.

See also

Retrieved from "https://www.wikidoc.org/index.php?title=Nocturia&oldid=1696231"