Common behavioral therapies appear to ease nocturia in men with low bladder capacity, according to researchers.

Matthew Epstein, MD, and colleagues from SUNY Downstate College of Medicine in New York analyzed voiding diaries from 27 patients with low global bladder capacity (maximum voided volume less than 200 mL) and 17 patients with low nocturnal bladder capacity (maximum voided volume less than 200 mL only at night) treated at a Veterans Affairs urology clinic. Each patient completed a 24-hour voiding diary at baseline and a month or more later.

Experiencing 1 less nocturia episode between diaries was considered response. Responders with low global bladder capacity had significantly lower nocturnal urine volume (NUV) than non-responders (−140 vs +75 mL) and scored significantly lower on the nocturnal bladder capacity index (NBCi; −0.59 vs +0.23), the investigators reported in Neurourology and Urodynamics. The same trend was observed for responders with low nocturnal bladder capacity: NUV (−30 vs +160 mL) and NBCi (−1.4 vs +0.33) declined. Neither group experienced an increase in maximum voided volume overall or at night.

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“Taken together, positive response to nocturia treatment appears to be mediated by closer alignment of nocturnal voided volume and bladder capacity, as well as by minimization of fluid intake and diminished nocturnal urine volume,” Dr Epstein and his colleagues stated. They added that behavioral techniques such as bladder training, pelvic floor exercises, and urge suppression help patients to void closer to capacity.

The study was not powered to determine effects of specific treatments.

“Whether methods of modifying nocturnal urine production through use of desmopressin, timed diuretics, continuous positive airway pressure (in sleep apnea patients), or antihypertensive medication for nondipping nocturnal blood pressure remains to be seen and justify future investigative efforts,” the authors wrote.

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Epstein MR, Monaghan T, Weiss JP. Etiology of nocturia response in men with diminished bladder capacity. Neurourol Urodynam. 2018;1–8. DOI:10.1002/nau.23832