Nocturia: aetiology and treatment in adults

Nocturia: aetiology and treatment in adults

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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. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $209.00 per year only $17.42 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS NOCTURIA AND OBSTRUCTIVE SLEEP APNOEA Article 23 May 2024 HYPERTENSION, CARDIOVASCULAR DISEASE, AND NOCTURIA: A SYSTEMATIC REVIEW OF THE PATHOPHYSIOLOGICAL MECHANISMS Article 03 March 2021 ASSOCIATION BETWEEN NOCTURIA AND SLEEP ISSUES, INCORPORATING THE IMPACT OF LIFESTYLE HABITS PERCEIVED AS PROMOTING SLEEP IN AN INTERNET SURVEY Article Open access 20 May 2025 REFERENCES * 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  * 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  * 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  * Bosch, J. L. & Weiss, J. P. The prevalence and causes of nocturia. _J. Urol._ 189, S86–S92 (2013). Article  PubMed  Google Scholar  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * Bliwise, D. L. _ et al_. Nocturia and disturbed sleep in the elderly. _Sleep Med._ 10, 540–548 (2009). Article  PubMed  Google Scholar  * 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  * 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  * Keenan, S. A. Normal human sleep. _Respir. Care Clin. N. Am._ 5, 319–331 (1999). CAS  PubMed  Google Scholar  * 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  * 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  * 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). * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * Verbalis, J. G. Renal physiology of nocturia. _Neurourol. Urodyn._ 33, S6–S9 (2014). Article  PubMed  Google Scholar  * 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  * 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  * Robertson, G. L. Differential diagnosis of polyuria. _Annu. Rev. Med._ 39, 425–442 (1988). Article  CAS  PubMed  Google Scholar  * Jordan, A. S., McSharry, D. G. & Malhotra, A. Adult obstructive sleep apnoea. _Lancet_ 383, 736–747 (2014). Article  PubMed  Google Scholar  * Saito, Y. Roles of atrial natriuretic peptide and its therapeutic use. _J. Cardiol._ 56, 262–270 (2010). Article  PubMed  Google Scholar  * 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  * 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  * Kim, J. W. Effect of shift work on nocturia. _Urology_ 87, 153–160 (2016). Article  PubMed  Google Scholar  * Weiss, J. P. _Nocturia: Causes, Consequences and Clinical Approaches_ (Springer, 2012). Book  Google Scholar  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * Maggi, C. A. Prostanoids as local modulators of reflex micturition. _Pharmacol. Res._ 25, 13–20 (1992). Article  CAS  PubMed  Google Scholar  * 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  * Caldwell, P. H., Deshpande, A. V. & Von Gontard, A. Management of nocturnal enuresis. _BMJ_ 347, f6259 (2013). Article  PubMed  Google Scholar  * 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  * Andersson, K. C. _ et al_. _Pharmacologic treatment of urinary incontinence_ (eds Abrams, P. C. _ et al_.) (EAU-ICUD, 2013). Google Scholar  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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). * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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 * Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, 11226, New York, USA Hasan Dani, Ashanda Esdaille & Jeffrey P. Weiss Authors * Hasan Dani View author publications You can also search for this author inPubMed Google Scholar * Ashanda Esdaille View author publications You can also search for this author inPubMed Google Scholar * Jeffrey P. Weiss View author publications You can also search for this author inPubMed 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 POWERPOINT SLIDE FOR TABLE 1 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE 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: 26 July 2016 * Issue Date: October 2016 * DOI: https://doi.org/10.1038/nrurol.2016.134 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

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.


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support SIMILAR CONTENT BEING VIEWED BY OTHERS NOCTURIA AND OBSTRUCTIVE SLEEP APNOEA Article 23 May 2024 HYPERTENSION, CARDIOVASCULAR DISEASE, AND NOCTURIA: A SYSTEMATIC REVIEW OF THE


PATHOPHYSIOLOGICAL MECHANISMS Article 03 March 2021 ASSOCIATION BETWEEN NOCTURIA AND SLEEP ISSUES, INCORPORATING THE IMPACT OF LIFESTYLE HABITS PERCEIVED AS PROMOTING SLEEP IN AN INTERNET


SURVEY Article Open access 20 May 2025 REFERENCES * 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  * 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  * 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  * Bosch, J. L. & Weiss, J. P. The prevalence and


causes of nocturia. _J. Urol._ 189, S86–S92 (2013). Article  PubMed  Google Scholar  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  *


Bliwise, D. L. _ et al_. Nocturia and disturbed sleep in the elderly. _Sleep Med._ 10, 540–548 (2009). Article  PubMed  Google Scholar  * 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  * 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  * Keenan, S. A. Normal human sleep. _Respir. Care Clin. N. Am._ 5, 319–331 (1999). CAS  PubMed  Google Scholar  * 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  * 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  * 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). * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  *


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 


* 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * Verbalis, J. G. Renal physiology of nocturia. _Neurourol.


Urodyn._ 33, S6–S9 (2014). Article  PubMed  Google Scholar  * 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  * 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  * Robertson, G. L. Differential diagnosis of polyuria. _Annu. Rev. Med._ 39, 425–442 (1988). Article  CAS 


PubMed  Google Scholar  * Jordan, A. S., McSharry, D. G. & Malhotra, A. Adult obstructive sleep apnoea. _Lancet_ 383, 736–747 (2014). Article  PubMed  Google Scholar  * Saito, Y. Roles


of atrial natriuretic peptide and its therapeutic use. _J. Cardiol._ 56, 262–270 (2010). Article  PubMed  Google Scholar  * 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  * 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  * Kim, J. W.


Effect of shift work on nocturia. _Urology_ 87, 153–160 (2016). Article  PubMed  Google Scholar  * Weiss, J. P. _Nocturia: Causes, Consequences and Clinical Approaches_ (Springer, 2012).


Book  Google Scholar  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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


  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * Maggi, C. A. Prostanoids as local modulators of reflex micturition. _Pharmacol. Res._ 25, 13–20 (1992). Article  CAS  PubMed  Google Scholar  * 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  * Caldwell, P. H., Deshpande, A. V. & Von Gontard, A. Management of nocturnal enuresis. _BMJ_ 347, f6259


(2013). Article  PubMed  Google Scholar  * 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  * Andersson, K. C. _ et al_. _Pharmacologic treatment of urinary incontinence_ (eds Abrams, P. C. _ et al_.) (EAU-ICUD, 2013). Google


Scholar  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  *


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  * 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  * 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  * 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


  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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). * 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  * 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  * 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  * 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  * 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  * 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  * 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  *


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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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 * Department of Urology, SUNY Downstate College of


Medicine, 450 Clarkson Avenue, Brooklyn, 11226, New York, USA Hasan Dani, Ashanda Esdaille & Jeffrey P. Weiss Authors * Hasan Dani View author publications You can also search for this


author inPubMed Google Scholar * Ashanda Esdaille View author publications You can also search for this author inPubMed Google Scholar * Jeffrey P. Weiss View author publications You can


also search for this author inPubMed 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 POWERPOINT SLIDE


FOR TABLE 1 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Dani, H., Esdaille, A. & Weiss, J. Nocturia: aetiology and treatment in adults. _Nat Rev


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