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Nocturia

Definition of Nocturia

The International Continence Society defines Nocturia as a complaint that the individual has to wake at night one or more times to void (Kerrebroeck et al., 2002) (Weiss, 2006)..

Differential Diagnosis of Nocturia

Nocturia due to General Polyuria:

Diabetes mellitus
Diabetes insipidus
(Psychogenic) polydipsia

Nocturia due to Nocturnal Polyuria:

Disorder of the circadian vasopressin secretion in the elderly.
Right-sided heart failure: increased wall tension of the right atrium through the horizontal sleeping position leads to an increased release of ANF (atrial natriuretic peptide) and thus to fluid secretion. In addition, fluid from the lower extremities (leg edema) is returned again to the blood stream at night.
Sleep apnea: hypoxia during the night leads to pulmonary vasoconstriction, this causes an increased wall tension of the right atrium and the release of ANF.
Diuretics given in the evening

Nocturia due to Reduced Bladder Capacity:

Advanced bladder cancer
Advanced prostate cancer
Radiation cystitis
Bladder pain syndrome or interstitial cystitis
Tuberculosis of the bladder

Nocturia due to Reduced Functional Bladder Capacity:

Residual urine (subvesical obstruction or neurogenic lower urinary tract dysfunction)
Bladder stones

Pharmacological causes of nocturia:

Diuretics, beta-blocker, theophylline or caffeine, especially when taken in the evening.

Nocturia due to Detrusor Instability:

Neurogenic lower urinary tract dysfunction
Overactive bladder
Bladder inflammation
Distal ureteral stone

Diagnostic Workup of Nocturia

Micturition diary: helps to differentiate between nocturnal polyuria (night time urine volume inclusive the first morning micturition) or reduced bladder capacity.
Residual urine
Urine flow to check for subvesical obstruction
Urodynamics in cases with neurogenic or unclear micturition disorders
Medical evaluation in nocturnal polyuria and heart or lung disease.

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References

van Kerrebroeck, P.; Abrams, P.; Chaikin, D.; Donovan, J.; Fonda, D.; Jackson, S.; Jennum, P.; Johnson, T.; Lose, G.; Mattiasson, A.; Robertson, G.; Weiss, J. & of the International Continence Society The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society.
Neurourol Urodyn, 2002, 21, 179-183.

Weiss, J. P. Nocturia: "do the math".
J Urol, 2006, 175, S16-S18

Deutsche Version: Nykturie

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