EURURO Vol. 72 No. 5

770 860

Platinum Priority – Editorial
Referring to the article published on pp. 757–769 of this issue
Anything New for Nocturia?
Soo Jeong Kim Omar [1_TD$DIFF]Al Hussein[3_TD$DIFF] Alawamlh, Richard K. Lee
James Buchanan Brady Foundation, Department of Urology, Weill Cornell College of Cornell University, New York, NY, USA
In 2002, the International Continence Society standardized
the definition of nocturia as ‘‘the complaint that an individual
has to wake at night one or more times to void’’ . A recent
review demonstrated that nocturia in males is a prevalent
problem, affecting 11–35.2% of younger men (age 20–40 yr),
increasing to 68.9–93% of older men (age >70 yr) In the
elderly, nocturia is associated with impaired health, deterio-
ration of sleep and quality of life, and an increased risk of
death , which highlight the importance of proper
treatment of nocturia. Further complicating matters, noc-
turia can stem from multiple etiologies, including bladder
storage problems, global polyuria, nocturnal polyuria, sleep
disorders, or even a mixed etiology .
In this month’s issue of European Urology, Drake and
colleagues provide a thorough overview of medical
treatment for men with nocturia. The reviewed medical
interventions included conservative management, antidi-
uretic therapy, selective alpha-1 adrenergic antagonists,
antimuscarinics, beta-3 agonists, 5-alpha reductase inhibi-
tors, phosphodiesterase 5 inhibitors, diuretics, nonsteroidal
anti-inflammatory drugs, phytotherapy, and agents to
promote sleep. The authors provide recommendations for
each therapeutic class in order to guide patient manage-
ment (summarized in ).
Although several reviews and meta-analyses have been
published on the topic of nocturia, this study is the first
from the European Association of Urology (EAU) Guidelines
Panel to review solely the medical treatment options in
men. The International Consultations on Urological
Diseases (ICUD) Committee also performed a similar study
that evaluated published evidence on nocturia in men to
derive expert recommendations in 2015 (comparison
summarized in ). The two expert panels were largely
in agreement with their recommendations. Antidiuretics
showed the highest level of evidence and grade of
recommendation, with the caveats that (1) several of the
antidiuretic (desmopressin) studies included in the analy-
ses undertook dose titration with the active treatment, a
maneuver that could increase the likelihood of a positive
outcome in a randomized control trial, and (2) applicability
to the elderly population, which is disproportionately
affected by nocturia, is limited due the risk of hyponatremia.
Also interestingly, while the ICUD Committee concluded
that combination therapies such as alpha-adrenergic
antagonists and 5-alpha reductase inhibitors or antimus-
carinics and alpha-1 adrenergic blockers can significantly
improve the number of nocturnal micturitions over either
drug used separately or placebo , the EAU Guidelines
Panel stated that benefits with combination therapies were
not consistently observed and, therefore, did not make
formal recommendations.
As Drake et al duly note, nocturia is a complex entity
with multiple causative categories. Developing a successful
therapy for all patients with nocturia is highly unlikely. In
the era of personalized medicine, evaluating the efficacy of
different therapeutic interventions when they are targeted
to the clinical scenario of each individual patient will be
important.
available at
journal homepage:
DOI of original article: .
* Corresponding author. James Buchanan Brady Foundation, Department of Urology, Weill Cornell College of Cornell University, 425 East 61st Street,
12th Floor, New York, NY 10065, USA. Tel. +1 646-962-4811; Fax: +1 646-962-0140.
E-mail address: (S.J. Kim).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.