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Terminology, Epidemiology, Etiology, and Pathophysiology of Nocturia

P.v. Kerrebroeck and K-E. Andersson

Neurourology and Urodynamics, Volume 33, Issue S1, Pages S2-S5, April 2014


Editor's Comments:
(Guest Expert: Anastasios Athanasopoulos MD, PhD, University of Patras, Medical School, Head of Urodynamic Urology Unit, Patras, Greece)

Nocturia is a significantly underestimated medical problem which seriously affects patients’ quality of life. The authors of this article have rightly focused on the importance of appropriate diagnosis and the knowledge of multifactorial pathogenesis. Nocturnal polyuria in elderly patients is present in 85% of nocturia cases. Nocturnal polyuria is the increased urine production during night time. The ICS defines nocturnal polyuria as nocturnal urine production above 20% for young patients and 33% for older patients. A part from nocturnal polyuria, other urological causes of nocturia include reduced bladder capacity, detrusor overactivity and mixed etiologies. Furthermore, non urological causes can provoke nocturia. Such a causes are untreated diabetes melitus or insipidus, sleep disorders, uncompensated heart disease and primary polydipsia. The authors underline the importance of frequency-volume chart as the main tool to guide diagnosis and after that the appropriate treatment of nocturia. Especially for nocturnal polyuria, frequency-volume chart is the cornerstone for the diagnosis of this condition. The pathophysiology behind the nocturia falls into five main categories : global polyuria, reduced bladder capacity, sleep disorders and circadian clock disorders. It seems that the authors present an accurate point of view - although a key factor in the decision to consult a physician is patient’s bother , use of the word disorder rather complaint would support the medical seriousness of nocturia to the health of the patient. It is well known that more than two nocturnal voids is considered to be the clinically meaningful threshold associated with significant negative outcomes regarding health and well-being. An important element which is highlighted in this paper is the fact that despite nocturia traditionally has been regarded as a pronominally male condition, robust data support the evidence that it is just as prevalent in women as in men. In the new era of urology, the improved knowledge regarding nocturia, which is a basic symptom of lower urinary tract symptoms, gave the wisdom to understand that nocturia and especially nocturnal polyuria can be a pathological entity per se . Further research in the future will bring new knowledge concerning the pathophysiology of nocturia. Till the water becomes crystal clear, the physicians have to give the attention that nocturia deserves.

Nocturia, awaking from sleep to void, has a negative impact on health and well-being. Nocturia affects men and women and is more prevalent among the elderly. More than two nocturnal voids is considered to be a clinically meaningful threshold associated with significant negative outcomes for health and well-being, and the timing of awakening has a significant bearing on the negative consequences of nocturia. Several serious underlying pathophysiologic conditions may be associated with nocturia. A thorough history and assessment of number and times of voids, void volume, and fluid intake is essential for determining the etiology of a patient's nocturia. With data obtained from the frequency-volume chart (FVC), which is used to collect quantitative voiding data, a patient's nocturia may be classified as global polyuria, nocturnal polyuria, reduced bladder capacity, or a combination of these categories. Global polyuria is defined as 24-hr urinary output that exceeds 40 ml/kg body weight and results in increased 24-hr urinary frequency. Nocturnal polyuria is defined as more than 20% of daily urine output at night in young patients and more than 33% in elderly patients. Reduced bladder capacity may be a result of idiopathic or neurogenic detrusor overactivity, bladder outlet obstruction, or reduced nocturnal bladder capacity. The pathophysiology underlying the findings of the FVC falls into five main categories: global polyuria, nocturnal polyuria, reduced bladder capacity, sleep disorders, and circadian clock disorders. This review discusses the epidemiology, etiology, and pathophysiology of nocturia. 
Neurourol. Urodynam. 33:S2–S5, 2014. © 2014 Wiley Periodicals, Inc.