To guide diagnosis, evaluation, and individualized treatment of nocturia, the authors of a recently published paper in the Australian Journal of General Practice list 8 questions to ask patients, review physical examination and testing protocols, and discuss available therapeutic options.
The questions are part of the TANGO (Targeting the individual’s Aetiology of Nocturia Guide Outcomes) screening tool, which patients fill out. For each question, the authors provide key points to consider. Question 1, for example, asks, “How many times do you wake up at night to pass urine?” The authors state that clinicians should clarify the onset and duration of nocturia, number of awakenings at night, and relative bother. “In particular, waking from sleep with an urge to void should be differentiated from voids made ‘just in case,’ which are common in those who wake because of sleep disturbance,” they explained.
Questions 2 through 8, respectively, are “How much does nocturia bother you? What medications are you taking? How much is your bladder actually storing day and night? How much urine to you make overnight? Do you have hypertension or cardiac failure, with or without leg edema? Are you a good sleeper? Have we checked your hormone levels recently?
The authors, Wendy F. Bower, PhD, Associate Professor at the University of Melbourne and Senior Clinician Physiotherapist at the Royal Melbourne Hospital in Australia, and colleagues, noted that patients “may not raise nocturia as a concern as they mistakenly consider the symptom to be a normal part of ageing.”
Interventions will differ among patients and often will be a combination of approaches, they stated, adding that targeting interventions for individual etiologic factors will be required to address each patient’s modifiable causes of nocturia.
For individuals with persistent nocturnal polyuria, the only options are desmopressin and furosemide, Dr Bower’s team noted, cautioning that both drugs potentially cause hyponatremia. Patients aged 65 years and older should be screened for hyponatremia after 1 week of desmopressin/furosemide therapy and again at 1 and 6 months, of if there is a change in medication or health status.
Bower WF, Everaert K, Ong TJ et al. Questions to ask a patient with nocturia. Aust J Gen Pract. 2018;47:465-469.