Management of nocturia due to lower urinary tract symptoms of mixed etiologies: Exploratory findings and improvement strategies from the community of nocturia experts panel

Objective Nocturia imposes a high burden on patients and healthcare systems through disrupted sleep, reduced quality of life, and increased risks of falls and mortality. Although common in patients with overactive bladder (OAB) or benign prostatic hyperplasia (BPH), nocturia has a distinct pathogenesis not addressed by OAB or BPH medications. Desmopressin is the recommended treatment, especially for nocturnal polyuria; however, physicians often prioritize OAB or BPH over nocturnal symptoms, leading to inadequate care. Herein, we aimed to describe local patterns in the diagnosis and management of nocturia in predominantly Asian countries and propose strategies to close care gaps. Methods The selected experts ( n =12) in nocturia management across the region completed an online survey, which was followed by an online meeting to discuss the results, review local and international data, and propose educational strategies and clinical tools. Results The survey and discussion identified barriers among both patients and healthcare providers contributing to delayed diagnosis and inadequate management of nocturnal polyuria, including a focus on prioritization of OAB or BPH treatment over that of nocturia. Patient barriers to desmopressin use included misperceptions that nocturia is a normal part of aging and reluctance to add medications to their treatment regimens. Physician barriers included underestimation of nocturia’s impact on patients and greater familiarity with OAB or BPH medications than with desmopressin. Both groups were concerned about bladder diary burden and hyponatremia risk, although hyponatremia rates reported in survey responses were lower than those reported in clinical studies (approximately 1% vs . 6%). Conclusion We have included proposals, such as a simplified screening questionnaire, and educational strategies for physicians and patients that have the potential to improve the diagnosis and management of nocturia in patients with OAB or BPH. We have outlined these strategies for both patients and healthcare professionals and have offered suggestions to simplify diagnosis and patient monitoring.