Review – Voiding DysfunctionA Contemporary Assessment of Nocturia: Definition, Epidemiology, Pathophysiology, and Management—a Systematic Review and Meta-analysis
Introduction
Nocturia is a well-recognized, highly prevalent symptom in both men and women [1]. The term nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times to void” [2]. In epidemiological studies, nocturia is often associated with a range of other lower urinary tract symptoms (LUTS) and, especially in elderly patients, is often not seen as the principal symptom [3]. Nocturia is even considered by some authors as “normal” and is not considered a major reason for seeking treatment [4], [5]. Clearly, nocturia is a symptom, not a disease. Similarly, it is classified as one component of common urologic conditions harbored by community-dwelling individuals, such as LUTS, overactive bladder (OAB), and urinary incontinence. As a matter of fact, despite the high prevalence, diverse etiology, and clinical importance of nocturia, no existing guideline has specifically addressed the subject of nocturia and its management over the last decade since the first landmark ICS document [2].
The last decade has been marked by a growing interest in nocturia as a specific symptom, in particular considering its etiology and consequences. This movement has led a number of groups of experts to provide consensus statements and helpful collaborative documents to summarize the knowledge on nocturia. These publications have emphasized that nocturia is a symptom that has been underreported, understudied, and often not adequately considered [6], [7], [8]. The reports follow the introduction [9] and the further development of the concept of LUTS [10], which has heralded a new era for medical research and clinical practice improvement in the field of functional urology.
Given the growing interest in nocturia as an important cornerstone of LUTS, the aim of the present work was to provide a systematic review of the available scientific evidence regarding the definition, physiopathology, epidemiology, and management of nocturia.
Section snippets
Evidence acquisition
A systematic review was conducted based on a literature search through the PubMed/Medline, Embase, Scopus, Web of Science, and Cochrane Library databases using the keyword nocturia. The literature search was restricted to full-length articles, in the English language (for practical reasons), after 2000 and before April 2012.
A first selection was made based on the titles and abstracts of the papers. After removal of duplicates and the exclusion of conference abstracts, the articles were
Evidence synthesis
The initial search yielded 11 361 potential citations. After removal of duplicates and application of language limits, 1365 articles were considered and reviewed based on title and abstract. At the end of the process, 277 full papers were obtained and considered for inclusion in this review. The flow diagram is given in Figure 1.
Conclusions
Nocturia has been comprehensively studied; it is a highly prevalent symptom with multiple potential underlying pathophysiologic mechanisms, some of which may have life-threatening consequences. In addition to an adequate history and clinical examination, an FVC is the cornerstone of initial assessment of this symptom and is suggested as such in all modern guidelines. The treatment options are largely determined by the clinical context and the etiology of the nocturia (NP, 24-h polyuria, reduced
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