Nocturia Evaluation, Treatment Fall Short

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In a study, only 5% of nocturia and nocturnal polyuria were prescribed oral desmopressin.
In a study, only 5% of nocturia and nocturnal polyuria were prescribed oral desmopressin.

SAN FRANCISCO—Clinical evaluation and treatment of nocturia is modest at best, according to Siri Drangsholt, MD, of New York University Langone Medical Center in New York, who presented findings from a real-world study of nocturia patients at the American Urological Association's 2018 annual meeting.

Of 403 patients (59% female; mean age 71 years) referred to a functional urology practice, 93% reported 2 or more nocturia episodes nightly. The median number of nocturia episodes was 4. Nearly half (48%) of patients had received previous treatment, such as an alpha-blocker (19.6%), anticholinergic (26.8%), or B3 agonist (4.2%). Yet at the first visit, just 1 in 2 patients were asked to complete a frequency volume chart, and even fewer (63% of these patients) complied. Among completers, the most common etiologies of nocturia were nocturnal polyuria (76%) and overactive bladder (25%). Just 47% of completers experienced symptom improvement with multidrug therapy followed by an anticholinergic medication.

A similar proportion of patients (43%) who did not complete bladder diaries reported improvement. At the first visit, these patients were offered conservative behavioral therapies, pharmacologic treatment, physical therapy, or referral to a sleep study.

Overall, 65% of patients returned for a second visit. Seventy percent complied with the recommended intervention, and only 40% of these adherents experienced improvement.

Only half of all patients (48%) returned for a third visit. At this point, 88% had initiated intervention, but less than half (46%) reported a reduction in nocturia episodes by 2. The mean nocturia events from the first visit improved from 4.1 to 2.96 episodes per night by the third visit.

Although most patients had nocturnal polyuria, only 5% of all patients were prescribed desmopressin acetate tablets.

“Nocturia is a highly prevalent symptom associated with many different disease processes,” Dr Drangsholt told Renal & Urology News. “This study highlights the fact that currently employed measures tend to be nonspecific. Half of patients do not complete a bladder diary and responses to therapy are suboptimal. Further work is needed to increase patient satisfaction and improve treatment of this common condition.”

Reference

Drangsholt S, Slawin J, and Brucker B. Clinical evaluation and treatment of nocturia is modest at best. Presented at the American Urological Association's 2018 annual meeting in San Francisco, May 18–21. Poster MP27-14.

 

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