Urology Department, Ghent University Hospital, Ghent, Belgium.
Urology Department, UMC Utrecht, Utrecht, The Netherlands.
Neurourol Urodyn. 2019 Feb;38(2):478-498. doi: 10.1002/nau.23939. Epub 2019 Feb 19.
Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin.
Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence-Research Society (ICI-RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI-RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU).
Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate-specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow-up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia.
A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.
夜尿症患者在得到正确诊断和治疗之前需要面对许多困难。本文的目的是：总结夜尿症患者的就诊流程，探讨在现实世界中如何诊断和治疗夜尿症，并使用 Delphi 方法制定一个注重在开处方去氨加压素之前需要采取哪些步骤的实用算法。
证据来自现有的指南（Google、PubMed）、国际尿控协会（ICI-RS）2017 年会议、处方信息和 Delphi 小组（3 轮）。国际尿控协会发起了这项研究，作者代表 ICI-RS、欧洲泌尿外科学会、女性盆腔医学和泌尿生殖重建学会（SUFU）。
诊断方案：对所有病因进行病史采集、摄入日记（液体、食物）和膀胱日记的共识，但不关注其持续时间。盆腔（女性）或直肠（男性）检查、前列腺特异性抗原、血清钠检查（SSC）、肾功能、内分泌筛查：当判断有必要时进行。SSC 时的时间或空腹状态不重要。治疗方案：可以对没有多饮、心力衰竭、严重腿部水肿或阻塞性睡眠呼吸暂停综合征的安全候选者进行去氨加压素表型。生活方式干预可能是有用的。开始使用去氨加压素：对三种临床情况的风险管理共识。去氨加压素治疗的随访：在第 3 至 7 天和第 1 个月对 SSC 进行了共识。如果 SSC<130mmol/L，无论症状如何，都应停止治疗。如果 SSC 在 130 至 135mmol/L 之间且有低钠血症症状，应停止治疗。
总结不同医学专家的夜尿症患者就诊流程有助于对患者进行可视化和表型分析，以进行诊断和治疗。通过总结去氨加压素的基本知识，我们旨在简化其使用，并缩短夜尿症患者的就诊流程。
