Nocturnal LUTS made easy for office urologist: how should we diagnose and treat from a lifelong perspective?

: Background Nocturnal lower urinary tract symptoms (LUTS), including enuresis, nocturia, and nocturnal incontinence, present differently across the lifespan, with growing relevance of cardiorenal contributors in later life. These symptoms arise from age-specific disruptions in the circadian regulation of the brain, kidney, and bladder, often modified by developmental transitions and comorbid conditions. Objective To provide a clinically relevant overview of nocturnal LUTS from childhood to advanced age, highlighting diagnostic priorities and treatment strategies tailored to life stage and symptom phenotype. Methods This narrative review synthesises current evidence on the pathophysiology and management of nocturnal LUTS, organised by age group. Key transitional phases; namely childhood, puberty, menopause, and frailty, are examined for their impact on symptom evolution. Results Although the underlying mechanisms may differ with age, a consistent diagnostic framework applies across all groups: careful history-taking, targeted examination, and symptom quantification through appropriately chosen bladder diaries. In children and adolescents, structured urotherapy forms the basis of care, while in adults, adaptation of lifestyle factors, including sleep and circadian realignment are the focus of interest. Older and frail patients require broader assessment due to comorbidity, sleep disturbance, polypharmacy, and cardiorenal mechanisms contributing to biphasic nocturnal diuresis. Pharmacological treatment, including desmopressin and antimuscarinics, should be guided by phenotype and used cautiously in vulnerable populations. Conclusion Nocturnal LUTS reflect a continuum of age-related phenotypes, requiring individualised, pathophysiology-based care. Aligning management with both symptom phenotype and life stage would improve outcomes across the lifespan, while greater attention to the sleep factor in all age groups and to cardiorenal drivers in older adults might enhance the precision and safety of care.