Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Nocturia: aetiology and treatment in adults

Nature Reviews Urology volume 13, pages 573–583 (2016)Cite this article

Subjects

Key Points

  • Nocturia remains underreported and undertreated, despite its prevalence and association with significant morbidity and mortality

  • Nocturia has multiple aetiologies, including overproduction of urine (global polyuria and nocturnal polyuria), reduced bladder storage capacity, sleep disorders and a combination of these conditions

  • The frequency volume chart, Nocturia Quality of Life questionnaire and the duration of the first uninterrupted sleep period should be used in the assessment and follow-up monitoring of each patient

  • Management strategies should be targeted to each patient's specific aetiology of nocturia; some patients might require multicomponent therapies

Abstract

Nocturia is an extremely common condition that has major sequelae for affected patients. Through disruption of sleep, nocturia impairs quality of life and worsens health outcomes, and is associated with a variety of morbidities including diabetes, coronary artery disease, obstructive sleep apnoea, obesity, metabolic syndrome, and depression. Unsurprisingly, several studies have also linked nocturia with reduced survival. Nocturia is not simply a consequence of lower urinary tract disease; rather, it is a multifactorial disorder that is often a manifestation of an underlying renal or systemic disease. Through the use of the frequency volume chart, clinicians can accurately quantify nocturia and determine its aetiology. Evaluation of quality of life and sleep using simple measures is essential in order to assess the impact of nocturia on a patient. Numerous treatment options for nocturia exist, but most are associated with minor benefit or lack sufficient evidence supporting their use. By systematically analysing an individual's causes of nocturia, clinicians can design appropriate treatment strategies to most effectively treat this condition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. van Kerrebroeck, P. et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn. 21, 179–183 (2002).

    Article  PubMed  Google Scholar 

  2. Tikkinen, K. A. et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur. Urol. 57, 488–496 (2010).

    Article  PubMed  Google Scholar 

  3. Kupelian, V. et al. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J. Urol. 185, 571–577 (2011).

    Article  PubMed  Google Scholar 

  4. Bosch, J. L. & Weiss, J. P. The prevalence and causes of nocturia. J. Urol. 189, S86–S92 (2013).

    Article  PubMed  Google Scholar 

  5. Chen, F. Y. et al. Perception of nocturia and medical consulting behavior among community-dwelling women. Int. Urogynecol. J. Pelvic Floor Dysfunct. 18, 431–436 (2007).

    Article  PubMed  Google Scholar 

  6. Welliver, C. et al. Analyzing why men seek treatment for lower urinary tract symptoms and factors associated with non-improvement. Urology 86, 862–867 (2015).

    Article  PubMed  Google Scholar 

  7. Fitzgerald, M. P., Litman, H. J., Link, C. L., McKinlay, J. B. & BACH Survey Investigators. The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J. Urol. 177, 1385–1389 (2007).

    Article  PubMed  Google Scholar 

  8. Agarwal, A. et al. What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women. Eur. Urol. 65, 1211–1217 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zhang, L. et al. A population-based survey of the prevalence, potential risk factors, and symptom-specific bother of lower urinary tract symptoms in adult Chinese women. Eur. Urol. 68, 97–112 (2015).

    Article  PubMed  Google Scholar 

  10. Miranda Ede, P. et al. Nocturia is the lower urinary tract symptom with greatest impact on quality of life of men from a community setting. Int. Neurourol. J. 18, 86–90 (2014).

    Article  PubMed  Google Scholar 

  11. Aikawa, K. et al. Elucidation of the pattern of the onset of male lower urinary tract symptoms using cluster analysis: efficacy of tamsulosin in each symptom group. Urology 86, 349–353 (2015).

    Article  PubMed  Google Scholar 

  12. Chartier-Kastler, E. & Chapple, C. R. LUTS/BPH in clinical practice: the importance of nocturia and quality of sleep. BJU Int. 98, 3–8 (2006).

    Article  Google Scholar 

  13. Kupelian, V. et al. Nocturia and quality of life: results from the Boston area community health survey. Eur. Urol. 61, 78–84 (2012).

    Article  PubMed  Google Scholar 

  14. Bliwise, D. L. et al. Nocturia and disturbed sleep in the elderly. Sleep Med. 10, 540–548 (2009).

    Article  PubMed  Google Scholar 

  15. Obayashi, K., Saeki, K. & Kurumatani, N. Quantitative association between nocturnal voiding frequency and objective sleep quality in the general elderly population: the HEIJO-KYO cohort. Sleep Med. 16, 577–582 (2015).

    Article  PubMed  Google Scholar 

  16. Parthasarathy, S. et al. Nocturia, sleep-disordered breathing, and cardiovascular morbidity in a community-based cohort. PLoS ONE 7, e30969 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Keenan, S. A. Normal human sleep. Respir. Care Clin. N. Am. 5, 319–331 (1999).

    CAS  PubMed  Google Scholar 

  18. Tasali, E., Leproult, R., Ehrmann, D. A. & Van Cauter, E. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc. Natl Acad. Sci. USA 105, 1044–1049 (2008).

    Article  PubMed  Google Scholar 

  19. Herzog, N. et al. Selective slow wave sleep but not rapid eye movement sleep suppression impairs morning glucose tolerance in healthy men. Psychoneuroendocrinology 38, 2075–2082 (2013).

    Article  CAS  PubMed  Google Scholar 

  20. Cedernaes, J. et al. A single night of partial sleep loss impairs fasting insulin sensitivity but does not affect cephalic phase insulin release in young men. J. Sleep Res. http://dx.doi.org/10.1111/jsr.12340 (2015).

  21. Chami, H. A., Gottlieb, D. J., Redline, S. & Punjabi, N. M. Association between glucose metabolism and sleep-disordered breathing during REM sleep. Am. J. Respir. Crit. Care Med. 192, 1118–1126 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kudlow, P. A., Cha, D. S., Lam, R. W. & McIntyre, R. S. Sleep architecture variation: a mediator of metabolic disturbance in individuals with major depressive disorder. Sleep Med. 14, 943–949 (2013).

    Article  CAS  PubMed  Google Scholar 

  23. Fung, M. M. et al. Decreased slow wave sleep increases risk of developing hypertension in elderly men. Hypertension 58, 596–603 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. van Kerrebroeck, P. et al. Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study. Eur. Urol. 52, 221–229 (2007).

    Article  CAS  PubMed  Google Scholar 

  25. Torimoto, K. et al. Evaluation of sleep quantity and quality in older adults with nocturia using portable electroencephalogram acquisition. J. Urol. 189, e557–e558 (2013).

    Article  Google Scholar 

  26. Finan, P. H., Quartana, P. J. & Smith, M. T. The effects of sleep continuity disruption on positive mood and sleep architecture in healthy adults. Sleep 38, 1735–1742 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bliwise, D. L., Dijk, D. J. & Juul, K. V. Nocturia is associated with loss of deep sleep independently from sleep apnea. Neurourol. Urodyn. 34, 392 (2015).

    Article  PubMed  Google Scholar 

  28. Bliwise, D. L., Holm-Larsen, T., Goble, S. & Norgaard, J. P. Short time to first void is associated with lower whole-night sleep quality in nocturia patients. J. Clin. Sleep Med. 11, 53–55 (2015).

    PubMed  PubMed Central  Google Scholar 

  29. Bliwise, D. L., Holm-Larsen, T. & Goble, S. Increases in duration of first uninterrupted sleep period are associated with improvements in PSQI-measured sleep quality. Sleep Med. 15, 1276–1278 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Buysse, D. J., Reynolds, C. F. 3rd, Monk, T. H., Berman, S. R. & Kupfer, D. J. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 28, 193–213 (1989).

    Article  CAS  PubMed  Google Scholar 

  31. Bliwise, D., Juul, K. V., Larsen, T., Van der Meulen, E. & Norgaard, J. P. Increase in first undisturbed sleep period (FUSP) is associated with a reduction in random blood glucose in nocturia patients. Eur. Urol. Suppl. 14, e550–e550a (2015).

    Article  Google Scholar 

  32. Lightner, D. J. et al. Nocturia is associated with an increased risk of coronary heart disease and death. BJU Int. 110, 848–853 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bursztyn, M., Jacob, J. & Stessman, J. Usefulness of nocturia as a mortality risk factor for coronary heart disease among persons born in 1920 or 1921. Am. J. Cardiol. 98, 1311–1315 (2006).

    Article  PubMed  Google Scholar 

  34. Fan, Y., Wei, F., Lang, Y. & Qi, W. Meta-analysis of nocturia and risk of all-cause mortality in adult population. Int. J. Cardiol. 195, 120–122 (2015).

    Article  PubMed  Google Scholar 

  35. Nakagawa, H. et al. Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J. Urol. 184, 1413–1418 (2010).

    Article  PubMed  Google Scholar 

  36. van Doorn, B., Kok, E. T., Blanker, M. H., Westers, P. & Bosch, J. L. Mortality in older men with nocturia. A 15-year followup of the Krimpen study. J. Urol. 187, 1727–1731 (2012).

    Article  PubMed  Google Scholar 

  37. Parsons, J. K. et al. Lower urinary tract symptoms increase the risk of falls in older men. BJU Int. 104, 63–68 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Temml, C. et al. Nocturia is an age-independent risk factor for hip-fractures in men. Neurourol. Urodyn. 28, 949–952 (2009).

    Article  PubMed  Google Scholar 

  39. Cappuccio, F. P., D'Elia, L., Strazzullo, P. & Miller, M. A. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 33, 585–592 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Dew, M. A. et al. Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom. Med. 65, 63–73 (2003).

    Article  PubMed  Google Scholar 

  41. Ensrud, K. E. et al. Sleep disturbances and risk of frailty and mortality in older men. Sleep Med. 13, 1217–1225 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Tikkinen, K. A. et al. A systematic evaluation of factors associated with nocturia — the population-based FINNO study. Am. J. Epidemiol. 170, 361–368 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kupelian, V. et al. Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston Area Community Health Survey. J. Urol. 182, 616–624; discussion 624–625 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Liao, C. H., Chiang, H. S. & Yu, H. J. Serum testosterone levels significantly correlate with nocturia in men aged 40–79 years. Urology 78, 631–635 (2011).

    Article  PubMed  Google Scholar 

  45. Tikkinen, K. A. et al. Reproductive factors associated with nocturia and urinary urgency in women: a population-based study in Finland. Am. J. Obstet. Gynecol. 199, 153.e1–153.e12 (2008).

    Article  Google Scholar 

  46. Bouwman, I. I. et al. Do lower urinary tract symptoms predict cardiovascular diseases in older men? A systematic review and meta-analysis. World J. Urol. 33, 1911–1920 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Bockenhauer, D. & Bichet, D. G. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat. Rev. Nephrol. 11, 576–588 (2015).

    Article  CAS  PubMed  Google Scholar 

  48. Nielsen, S., Kwon, T. H., Frokiaer, J. & Agre, P. Regulation and dysregulation of aquaporins in water balance disorders. J. Intern. Med. 261, 53–64 (2007).

    Article  CAS  PubMed  Google Scholar 

  49. Verbalis, J. G. Renal physiology of nocturia. Neurourol. Urodyn. 33, S6–S9 (2014).

    Article  PubMed  Google Scholar 

  50. Hofmeester, I. et al. The association between nocturia and nocturnal polyuria in clinical and epidemiological studies: a systematic review and meta-analyses. J. Urol. 191, 1028–1033 (2014).

    Article  PubMed  Google Scholar 

  51. Gulur, D. M., Mevcha, A. M. & Drake, M. J. Nocturia as a manifestation of systemic disease. BJU Int. 107, 702–713 (2011).

    Article  PubMed  Google Scholar 

  52. Robertson, G. L. Differential diagnosis of polyuria. Annu. Rev. Med. 39, 425–442 (1988).

    Article  CAS  PubMed  Google Scholar 

  53. Jordan, A. S., McSharry, D. G. & Malhotra, A. Adult obstructive sleep apnoea. Lancet 383, 736–747 (2014).

    Article  PubMed  Google Scholar 

  54. Saito, Y. Roles of atrial natriuretic peptide and its therapeutic use. J. Cardiol. 56, 262–270 (2010).

    Article  PubMed  Google Scholar 

  55. Witthaus, M. W. et al. Bladder oxidative stress in sleep apnea contributes to detrusor instability and nocturia. J. Urol. 193, 1692–1699 (2015).

    Article  CAS  PubMed  Google Scholar 

  56. Obayashi, K., Saeki, K. & Kurumatani, N. Association between melatonin secretion and nocturia in elderly individuals: a cross-sectional study of the HEIJO-KYO cohort. J. Urol. 191, 1816–1821 (2014).

    Article  CAS  PubMed  Google Scholar 

  57. Kim, J. W. Effect of shift work on nocturia. Urology 87, 153–160 (2016).

    Article  PubMed  Google Scholar 

  58. Weiss, J. P. Nocturia: Causes, Consequences and Clinical Approaches (Springer, 2012).

    Book  Google Scholar 

  59. Abrams, P. et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol. Urodyn. 21, 167–178 (2002).

    Article  PubMed  Google Scholar 

  60. Hashim, H. & Abrams, P. Is the bladder a reliable witness for predicting detrusor overactivity? J. Urol. 175, 191–194; discussion 194–195 (2006).

    Article  CAS  PubMed  Google Scholar 

  61. Al-Zahrani, A. A. & Gajewski, J. Urodynamic findings in women with refractory overactive bladder symptoms. Int. J. Urol. 23, 75–79 (2016).

    Article  PubMed  Google Scholar 

  62. Matharu, G., Donaldson, M. M., McGrother, C. W. & Matthews, R. J. Relationship between urinary symptoms reported in a postal questionnaire and urodynamic diagnosis. Neurourol. Urodyn. 24, 100–105 (2005).

    Article  CAS  PubMed  Google Scholar 

  63. Krystal, A. D., Preud'homme, X. A., Amundsen, C. L. & Webster, G. D. Detrusor overactivity persisting at night and preceding nocturia in patients with overactive bladder syndrome: a nocturnal cystometrogram and polysomnogram study. J. Urol. 184, 623–628 (2010).

    Article  PubMed  Google Scholar 

  64. Oelke, M. et al. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur. Urol. 54, 419–426 (2008).

    Article  PubMed  Google Scholar 

  65. Oh, M. M. et al. Is there a correlation between the presence of idiopathic detrusor overactivity and the degree of bladder outlet obstruction? Urology 77, 167–170 (2011).

    Article  PubMed  Google Scholar 

  66. Araujo, A. B. et al. Sleep related problems and urological symptoms: testing the hypothesis of bidirectionality in a longitudinal, population based study. J. Urol. 191, 100–106 (2014).

    Article  PubMed  Google Scholar 

  67. Weinberger, J. M., Weiss, J. P., Kashan, M. & Blaivas, J. G. Nocturia: why do people void at night? J. Urol. 189, e800–e801 (2013).

    Article  Google Scholar 

  68. Cornu, J. N. et al. A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management — a systematic review and meta-analysis. Eur. Urol. 62, 877–890 (2012).

    Article  PubMed  Google Scholar 

  69. Weiss, J. P., Blaivas, J. G., Stember, D. S. & Brooks, M. M. Nocturia in adults: etiology and classification. Neurourol. Urodyn. 17, 467–472 (1998).

    Article  CAS  PubMed  Google Scholar 

  70. Marshall, S. D. et al. Nocturia: current levels of evidence and recommendations from the International Consultation on Male Lower Urinary Tract Symptoms. Urology 85, 1291–1299 (2015).

    Article  PubMed  Google Scholar 

  71. van Haarst, E. P. & Bosch, J. L. The optimal duration of frequency-volume charts related to compliance and reliability. Neurourol. Urodyn. 33, 296–301 (2014).

    Article  PubMed  Google Scholar 

  72. Burton, C., Weiss, J. P., Parsons, M., Blaivas, J. G. & Coats, A. C. Reference values for the Nocturnal Bladder Capacity Index. Neurourol. Urodyn. 30, 52–57 (2011).

    Article  PubMed  Google Scholar 

  73. Hofmeester, I. et al. Impact of the International Continence Society (ICS) report on the standardisation of terminology in nocturia on the quality of reports on nocturia and nocturnal polyuria: a systematic review. BJU Int. 115, 520–536 (2015).

    Article  PubMed  Google Scholar 

  74. Goessaert, A. S., Krott, L., Hoebeke, P., Vande Walle, J. & Everaert, K. Diagnosing the pathophysiologic mechanisms of nocturnal polyuria. Eur. Urol. 67, 283–288 (2015).

    Article  PubMed  Google Scholar 

  75. van Doorn, B., Blanker, M. H., Kok, E. T., Westers, P. & Bosch, J. L. Prevalence, incidence, and resolution of nocturnal polyuria in a longitudinal community-based study in older men: the Krimpen study. Eur. Urol. 63, 542–547 (2013).

    Article  PubMed  Google Scholar 

  76. van Haarst, E. P. & Bosch, J. L. A cutoff value based on analysis of a reference population decreases overestimation of the prevalence of nocturnal polyuria. J. Urol. 188, 869–873 (2012).

    Article  PubMed  Google Scholar 

  77. Abraham, L. et al. Development and validation of a quality-of-life measure for men with nocturia. Urology 63, 481–486 (2004).

    Article  PubMed  Google Scholar 

  78. Weiss, J. P., Zinner, N. R., Klein, B. M. & Norgaard, J. P. Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. Neurourol. Urodyn. 31, 441–447 (2012).

    Article  CAS  PubMed  Google Scholar 

  79. Cho, S. Y. et al. Short-term effects of systematized behavioral modification program for nocturia: a prospective study. Neurourol. Urodyn. 31, 64–68 (2012).

    Article  PubMed  Google Scholar 

  80. Miyazaki, T. et al. Nocturia in patients with sleep-disordered breathing and cardiovascular disease. Circ. J. 79, 2632–2640 (2015).

    Article  CAS  PubMed  Google Scholar 

  81. Wang, T., Huang, W., Zong, H. & Zhang, Y. The efficacy of continuous positive airway pressure therapy on nocturia in patients with obstructive sleep apnea: a systematic review and meta-analysis. Int. Neurourol. J. 19, 178–184 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  82. Miyazato, M. et al. Effect of continuous positive airway pressure on nocturnal urine production in patients with obstructive sleep apnea syndrome. Neurourol. Urodyn. 85, 333–336 (2015).

    Google Scholar 

  83. Reynard, J. M., Cannon, A., Yang, Q. & Abrams, P. A novel therapy for nocturnal polyuria: a double-blind randomized trial of frusemide against placebo. Br. J. Urol. 81, 215–218 (1998).

    Article  CAS  PubMed  Google Scholar 

  84. Maggi, C. A. Prostanoids as local modulators of reflex micturition. Pharmacol. Res. 25, 13–20 (1992).

    Article  CAS  PubMed  Google Scholar 

  85. Addla, S. K., Adeyoju, A. B., Neilson, D. & O'Reilly, P. Diclofenac for treatment of nocturia caused by nocturnal polyuria: a prospective, randomised, double-blind, placebo-controlled crossover study. Eur. Urol. 49, 720–725 (2006).

    Article  CAS  PubMed  Google Scholar 

  86. Caldwell, P. H., Deshpande, A. V. & Von Gontard, A. Management of nocturnal enuresis. BMJ 347, f6259 (2013).

    Article  PubMed  Google Scholar 

  87. Hammer, M. & Vilhardt, H. Peroral treatment of diabetes insipidus with a polypeptide hormone analog, desmopressin. J. Pharmacol. Exp. Ther. 234, 754–760 (1985).

    CAS  PubMed  Google Scholar 

  88. Andersson, K. C. et al. Pharmacologic treatment of urinary incontinence (eds Abrams, P. C. et al.) (EAU-ICUD, 2013).

    Google Scholar 

  89. Oelke, M. et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur. Urol. 64, 118–140 (2013).

    Article  PubMed  Google Scholar 

  90. Ebell, M. H., Radke, T. & Gardner, J. A systematic review of the efficacy and safety of desmopressin for nocturia in adults. J. Urol. 192, 829–835 (2014).

    Article  CAS  PubMed  Google Scholar 

  91. Juul, K. V., Klein, B. M. & Norgaard, J. P. Long-term durability of the response to desmopressin in female and male nocturia patients. Neurourol. Urodyn. 32, 363–370 (2013).

    Article  CAS  PubMed  Google Scholar 

  92. Weiss, J. P., Herschorn, S., Albei, C. D. & van der Meulen, E. A. Efficacy and safety of low dose desmopressin orally disintegrating tablet in men with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J. Urol. 190, 965–972 (2013).

    Article  CAS  PubMed  Google Scholar 

  93. Sand, P. K., Dmochowski, R. R., Reddy, J. & van der Meulen, E. A. Efficacy and safety of low dose desmopressin orally disintegrating tablet in women with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J. Urol. 190, 958–964 (2013).

    Article  CAS  PubMed  Google Scholar 

  94. Juul, K. V., Klein, B. M., Sandstrom, R., Erichsen, L. & Norgaard, J. P. Gender difference in antidiuretic response to desmopressin. Am. J. Physiol. Renal Physiol. 300, F1116–F1122 (2011).

    Article  CAS  PubMed  Google Scholar 

  95. Yamaguchi, O., Nishizawa, O., Juul, K. V. & Norgaard, J. P. Gender difference in efficacy and dose response in Japanese patients with nocturia treated with four different doses of desmopressin orally disintegrating tablet in a randomized, placebo-controlled trial. BJU Int. 111, 474–484 (2013).

    Article  CAS  PubMed  Google Scholar 

  96. Rembratt, A., Riis, A. & Norgaard, J. P. Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia. Neurourol. Urodyn. 25, 105–109 (2006).

    Article  CAS  PubMed  Google Scholar 

  97. Johnson, T. M. et al. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J. Urol. 178, 2045–2050; discussion 2050–2051 (2007).

    Article  CAS  PubMed  Google Scholar 

  98. Eisenhardt, A., Schneider, T., Cruz, F. & Oelke, M. Consistent and significant improvement of nighttime voiding frequency (nocturia) with silodosin in men with LUTS suggestive of BPH: pooled analysis of three randomized, placebo-controlled, double-blind phase III studies. World J. Urol. 32, 1119–1125 (2014).

    Article  PubMed  Google Scholar 

  99. Johnson, T. M. et al. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. J. Urol. 170, 145–148 (2003).

    Article  PubMed  Google Scholar 

  100. Roehrborn, C. G., Van Kerrebroeck, P. & Nordling, J. Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU Int. 92, 257–261 (2003).

    Article  CAS  PubMed  Google Scholar 

  101. Tanaka, T. et al. Efficacy of naftopidil for nocturia in male patients with lower urinary tract symptoms: comparison of morning and evening dosing. Int. J. Urol. 22, 317–321 (2015).

    Article  CAS  PubMed  Google Scholar 

  102. Oelke, M. et al. Effects of tadalafil on nighttime voiding (nocturia) in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a post hoc analysis of pooled data from four randomized, placebo-controlled clinical studies. World J. Urol. 32, 1127–1132 (2014).

    Article  CAS  PubMed  Google Scholar 

  103. Oelke, M. et al. Impact of dutasteride on nocturia in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a pooled analysis of three phase III studies. World J. Urol. 32, 1141–1147 (2014).

    Article  PubMed  Google Scholar 

  104. Oelke, M. et al. Nocturia improvement in the combination of Avodart(®) and tamsulosin (CombAT) study. World J. Urol. 32, 1133–1140 (2014).

    Article  CAS  PubMed  Google Scholar 

  105. Falahatkar, S., Mokhtari, G., Pourreza, F., Asgari, S. A. & Kamran, A. N. Celecoxib for treatment of nocturia caused by benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled study. Urology 72, 813–816 (2008).

    Article  PubMed  Google Scholar 

  106. Simaioforidis, V. et al. Tamsulosin versus transurethral resection of the prostate: effect on nocturia as a result of benign prostatic hyperplasia. Int. J. Urol. 18, 243–248 (2011).

    Article  PubMed  Google Scholar 

  107. Choi, W. S., Ku, J. H., Oh, S. J., Kim, S. W. & Paick, J. S. Change of nocturnal polyuria after holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia. Urology 84, 650–656 (2014).

    Article  PubMed  Google Scholar 

  108. Machino, R. et al. Detrusor instability with equivocal obstruction: a predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol. Urodyn. 21, 444–449 (2002).

    Article  PubMed  Google Scholar 

  109. de Nunzio, C. et al. The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction. J. Urol. 169, 535–539 (2003).

    Article  PubMed  Google Scholar 

  110. Weiss, J. P. et al. Efficacy and safety of flexible dose fesoterodine in men and women with overactive bladder symptoms including nocturnal urinary urgency. J. Urol. 189, 1396–1401 (2013).

    Article  CAS  PubMed  Google Scholar 

  111. Buser, N., Ivic, S., Kessler, T. M., Kessels, A. G. & Bachmann, L. M. Efficacy and adverse events of antimuscarinics for treating overactive bladder: network meta-analyses. Eur. Urol. 62, 1040–1060 (2012).

    Article  CAS  PubMed  Google Scholar 

  112. Yokoyama, O., Hiro, S., Hotta, S., Mogami, S. & Yamagami, H. Efficacy of fesoterodine on nocturia and quality of sleep in Asian patients with overactive bladder. Urology 83, 750–755 (2014).

    Article  PubMed  Google Scholar 

  113. Rackley, R. et al. Nighttime dosing with tolterodine reduces overactive bladder-related nocturnal micturitions in patients with overactive bladder and nocturia. Urology 67, 731–736; discussion 736 (2006).

    Article  PubMed  Google Scholar 

  114. Kaplan, S. A. et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 296, 2319–2328 (2006).

    Article  CAS  PubMed  Google Scholar 

  115. Kim, T. H. et al. Comparison of the efficacy and safety of 2 mg and 4 mg tolterodine combined with an alpha-blocker in men with lower urinary tract symptoms and overactive bladder: A randomised controlled trial. BJU Int. 117, 307–315 (2016).

    Article  CAS  PubMed  Google Scholar 

  116. Yokoyama, O. et al. Add-on anticholinergic therapy for residual nocturia in patients with lower urinary tract symptoms receiving α1-blocker treatment: a multi-centre, prospective, randomised study. World J. Urol. 33, 659–667 (2015).

    Article  CAS  PubMed  Google Scholar 

  117. Johnson, T. M. 2nd, Burgio, K. L., Redden, D. T., Wright, K. C. & Goode, P. S. Effects of behavioral and drug therapy on nocturia in older incontinent women. J. Am. Geriatr. Soc. 53, 846–850 (2005).

    Article  PubMed  Google Scholar 

  118. Johnson, T. M. et al. Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia. BJU Int. 112, 100–108 (2013).

    Article  CAS  PubMed  Google Scholar 

  119. Chapple, C. R. et al. A proof-of-concept study: mirabegron, a new therapy for overactive bladder. Neurourol. Urodyn. 32, 1116–1122 (2013).

    Article  CAS  PubMed  Google Scholar 

  120. Yamaguchi, O. et al. Safety and efficacy of mirabegron as 'add-on' therapy in patients with overactive bladder treated with solifenacin: a post-marketing, open-label study in Japan (MILAI study). BJU Int. 116, 612–622 (2015).

    Article  CAS  PubMed  Google Scholar 

  121. Kuo, H. C. et al. Results of a randomized, double-blind, parallel-group, placebo- and active-controlled, multicenter study of mirabegron, a β3-adrenoceptor agonist, in patients with overactive bladder in Asia. Neurourol. Urodyn. 34, 685–692 (2015).

    Article  CAS  PubMed  Google Scholar 

  122. Nitti, V. W. et al. Results of a randomized phase III trial of mirabegron in patients with overactive bladder. J. Urol. 189, 1388–1395 (2013).

    Article  CAS  PubMed  Google Scholar 

  123. Peters, K. M. et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J. Urol. 182, 1055–1061 (2009).

    Article  CAS  PubMed  Google Scholar 

  124. Canbaz Kabay, S. et al. Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12-months results. Neurourol. Urodyn. http://dx.doi.org/10.1002/nau.22868 (2015).

  125. Kabay, S. et al. The clinical and urodynamic results of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease. Urology 87, 76–81 (2016).

    Article  PubMed  Google Scholar 

  126. Sun, Y., Luo, D., Tang, C., Yang, L. & Shen, H. The safety and efficiency of onabotulinumtoxinA for the treatment of overactive bladder: a systematic review and meta-analysis. Int. Urol. Nephrol. 47, 1779–1788 (2015).

    Article  CAS  PubMed  Google Scholar 

  127. Hamidi Madani, A. et al. Transurethral intraprostatic Botulinum toxin-A injection: a novel treatment for BPH refractory to current medical therapy in poor surgical candidates. World J. Urol. 31, 235–239 (2013).

    Article  CAS  PubMed  Google Scholar 

  128. Wilt, T., Ishani, A., Mac Donald, R., Rutks, I. & Stark, G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst. Rev. 1, CD001044 (2002).

    Google Scholar 

  129. Wilt, T., Mac Donald, R., Ishani, A., Rutks, I. & Stark, G. Cernilton for benign prostatic hyperplasia. Cochrane Database Syst. Rev. 2, CD001042 (2000).

    Google Scholar 

  130. MacDonald, R., Tacklind, J. W., Rutks, I. & Wilt, T. J. Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 109, 1756–1761 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  131. Chiu, A. F., Huang, M. H., Wang, C. C. & Kuo, H. C. Higher glycosylated hemoglobin levels increase the risk of overactive bladder syndrome in patients with type 2 diabetes mellitus. Int. J. Urol. 19, 995–1001 (2012).

    Article  CAS  PubMed  Google Scholar 

  132. Tyagi, S. et al. Behavioral treatment of insomnia: also effective for nocturia. J. Am. Geriatr. Soc. 62, 54–60 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  133. Sugaya, K., Nishijima, S., Miyazato, M., Kadekawa, K. & Ogawa, Y. Effects of melatonin and rilmazafone on nocturia in the elderly. J. Int. Med. Res. 35, 685–691 (2007).

    Article  CAS  PubMed  Google Scholar 

  134. Drake, M. J., Mills, I. W. & Noble, J. G. Melatonin pharmacotherapy for nocturia in men with benign prostatic enlargement. J. Urol. 171, 1199–1202 (2004).

    Article  CAS  PubMed  Google Scholar 

  135. Vaughan, C. P., Endeshaw, Y., Nagamia, Z., Ouslander, J. G. & Johnson, T. M. A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results. BJU Int. 104, 69–74 (2009).

    Article  PubMed  Google Scholar 

  136. Kawahara, T. et al. Ramelteon combined with an α1-blocker decreases nocturia in men with benign prostatic hyperplasia. BMC Urol. 13, 30 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  137. Doo, S. W., Kim, J. H., Yang, W. J. & Song, Y. S. Is there any objective improvement of nocturia by combination treatment of zolpidem and alpha-blocker therapy for unresponsive to alpha-blocker monotherapy in men with lower urinary tract symptoms? Low. Urin. Tract. Symptoms 5, 134–139 (2013).

    Article  CAS  PubMed  Google Scholar 

  138. Miwa, K. et al. Efficacy of combination therapy with tamsulosin and zolpidem on nocturia in patients with benign prostatic hyperplasia. Cent. European J. Urol. 64, 232–235 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  139. Bae, W. J. et al. Desmopressin add-on therapy for refractory nocturia in men receiving α-blockers for lower urinary tract symptoms. J. Urol. 190, 180–186 (2013).

    Article  CAS  PubMed  Google Scholar 

  140. Cho, S. Y. et al. Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study. Int. Neurourol. J. 18, 213–220 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, 11226, New York, USA

    Hasan Dani, Ashanda Esdaille & Jeffrey P. Weiss

Authors
  1. Hasan Dani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashanda Esdaille
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey P. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J.P.W. and H.D. discussed the content for this article and wrote it, H.D. researched data for this article and all authors were involved in the review and editing of the article before submission.

Corresponding author

Correspondence to Jeffrey P. Weiss.

Ethics declarations

Competing interests

J.P.W. declares that he serves as consultant for Allergan, Astellas, Elsevier, Ferring, Pfizer, Symptelligence and Vantia. H.D. and A.E. declare no competing interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dani, H., Esdaille, A. & Weiss, J. Nocturia: aetiology and treatment in adults. Nat Rev Urol 13, 573–583 (2016). https://doi.org/10.1038/nrurol.2016.134

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2016.134

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing