Rigi10™ Malleable Penile Prosthesis
Also Known As
Nighttime urination, nocturnal urination, nighttime urinary frequency, nocturnal urinary frequency, nighttime voiding, nocturnal voiding
Definition
Nocturia is defined as the need for patients to wake up at night regularly to urinate, where a sleep period must precede and follow the urinary episode to count as a nocturnal void.1 It is often described as the most bothersome of all urinary symptoms and is also one of the most common.1 Nocturia can be associated with long-term sleep deprivation in addition to the inconvenience it causes.1
Nocturia is a multifactorial condition but generally is caused by one of four main problems: nocturnal polyuria, global polyuria, bladder functional storage issues, and sleep disorders.2 A combination of these can also lead to nocturia. According to the International Continence Society, nocturnal polyuria is a nighttime urinary production greater than 20% of the total 24-hour urine volume in younger adults or more than 33% in older individuals.2–3
Although nocturia is a multifactorial condition that can coexist with other lower urinary tract symptoms, the most common causal factor is nighttime overproduction of urine, which has been implicated in up to 88% of nocturia cases.4 Many people with nocturia do not seek help, accepting it as a natural consequence of aging. However, nocturia is common in men and women of all ages and has a profound impact on quality of life, especially in younger individuals, and may be associated with increased morbidity and mortality.4
Clinical Context
Nocturia is a condition that affects approximately 1 in 3 adults over the age of 30, with prevalence increasing with age.2 About 69% of men and 76% of women aged 40 years and older report at least one nocturnal void.2 The condition affects 4% to 18% of women in their 20s and 30s, increasing to 28% to 62% for women in their 70s and 80s. Similar ranges are reported in men, with 2% to 17% of men aged 20 to 30 years reporting two or more voids per night, rising to 29% to 59% in men aged 70 to 80 years.2
Clinically, nocturia is diagnosed when a patient reports waking up two or more times each night to urinate.1 The cornerstone of nocturia diagnosis and evaluation is the 24-hour voiding diary, which helps identify the underlying cause.1
The clinical management of nocturia depends on its etiology. For nocturnal polyuria, treatment may include timing of diuretic medications, evening fluid restriction, elevation of legs to mobilize fluid, and use of medications like desmopressin.3 For global polyuria, addressing the underlying cause (such as diabetes mellitus or diabetes insipidus) is essential.1 For bladder storage problems, anticholinergic medications or beta-agonists may be prescribed.5
Management strategies, which consist of lifestyle modification, behavioral therapy, and medications, should be offered to all patients with significant nocturia, at least on a trial basis, regardless of whether minimal discomfort is reported initially.1 Treatment of underlying conditions such as diabetes, high blood pressure, congestive heart failure, obstructive sleep apnea, and/or enlarged prostate (BPH) is also important.5