Oelke Matthias, De Wachter Stefan, Drake Marcus J, Giannantoni Antonella, Kirby Mike, Orme Susan, Rees Jonathan, van Kerrebroeck Philip, Everaert Karel
Department of Urology, University of Maastricht, Maastricht, The Netherlands.
Department of Urology, University of Antwerp, Antwerp, Belgium.
Int J Clin Pract. 2017 Nov;71(11). doi: 10.1111/ijcp.13027. Epub 2017 Oct 5.
To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.
A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.
Nocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged 70-80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia-related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency-volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low-dose, gender-specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid-late afternoon, dependent on the specific serum half-life. Patients not responding to these basic treatments should be referred for specialist management.
The cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.
提高对夜尿症疾病负担的认识，并提供简化的病因评估及相关治疗途径。
一个由夜尿症专家组成的多学科小组根据现有最佳证据并结合自身经验，制定了实用的建议和推荐。
夜尿症被定义为夜间睡眠期间需要排尿≥1次。具有临床意义的夜尿症（每晚≥2次排尿）在20 - 40岁人群中的发生率为2% - 18%，在70 - 80岁人群中则升至28% - 62%。其后果包括：生活质量下降；跌倒和骨折；工作效率降低；抑郁；以及死亡率增加。仅2014年，欧盟因夜尿症相关髋部骨折的花费约为10亿欧元，美国约为15亿美元。夜尿症的病理生理学是多因素的，通常与多尿（全身性或夜间性）、膀胱容量减少或液体摄入量增加有关。准确评估基于频率 - 尿量图表，并结合详细的患者病史、药物审查和体格检查。最佳治疗应针对潜在病因，首先进行生活方式调整（例如，减少夜间液体摄入量）。对于持续困扰的患者，应引入药物治疗；低剂量、针对性别的去氨加压素已被证明对特发性夜间多尿引起的夜尿症有效。利尿剂的服用时间是一个重要考虑因素，应根据具体的血清半衰期在下午中后期服用。对这些基本治疗无反应的患者应转诊至专科进行管理。
所有患者均应首先评估夜尿症的病因。之后，应针对潜在的病理生理学进行特异性治疗，可单独进行生活方式干预，或与药物或（前列腺）手术联合使用。
