#0183

Management of nocturia due to lower urinary tract symptoms of mixed etiologies: Recommendations from the Community of Nocturia Experts (CONE) panel

J. Hong¹, S. Cho², K. Everaert³, A. Furuta⁴, T. Kitta⁵, D. Le⁶, C. Lin⁷, T. Ng⁸, C. Oh⁹, T. Ong¹⁰, S. Pandey¹¹, P. Ramart¹², S. Yuen¹³

¹National Taiwan University Hospital, National Taiwan University, College of Medicine, Department of Urology, Taipei, Taiwan
²Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Department of Urology, Seoul, Korea (Republic of)
³Ghent University Hospital, Department of Urology, Ghent, Belgium
⁴Jikei University School of Medicine, Department of Urology, Tokyo, Japan
⁵Asahikawa Medical University, Department of Renal and Urologic Surgery, Asahikawa, Hokkaido, Japan
⁶Hue University Of Medicine and Pharmacy, Department of Urology, Hue city, Vietnam
⁷Taipei Veterans General Hospital, Department of Urology, Taipei, Taiwan
⁸Singapore General Hospital General Hospital, Department of Urology, Singapore, Singapore
⁹College of Medicine, Hallym University Sacred Heart Hospital, Department of Urology, Anyang, Korea (Republic of)
¹⁰Faculty of Medicine, Universiti Malaya, Department of Surgery, Kuala Lumpur, Malaysia
¹¹Kokilaben Dhirubhai Ambani Hospital, Department of Urology and Renal Transplant, Mumbai, India
¹²Faculty of Medicine, Siriraj Hospital, Mahidol University, Division of Urology, Bangkok, Thailand
¹³SH Ho Urology Centre, The Chinese University of Hong Kong, Department of Surgery, Hong Kong, Hong Kong, China

Introduction:

Nocturia imposes a high burden on patients and healthcare systems through disrupted sleep, reduced quality of life, and increased risks of falls and mortality. Although nocturia is common in patients with overactive bladder (OAB) or benign prostatic hyperplasia (BPH), it has a distinct pathogenesis that is not addressed by medications for OAB or BPH. Desmopressin is the recommended pharmacological treatment, especially for patients with nocturnal polyuria. However, international data show that physicians often prioritize treating OAB/BPH over nocturnal symptoms, leading to inadequate management of nocturia. Herein, we describe local patterns in the diagnosis and management of nocturia in Asian countries and propose strategies to close gaps in patient care.

Material and methods:

An international expert group, the Community of Nocturia Experts (CONE), comprising 13 urologists from Belgium, China, Hong Kong, India, Japan, Korea, Malaysia, Singapore, Taiwan, Thailand, and Vietnam, was convened to assess the burden of nocturia, review management guidelines, and examine regional clinical practices. A targeted literature review was conducted to gather data on epidemiology, treatment guidelines, and clinical challenges. Based on these findings, a 12-question online survey (refer to Table) was developed to assess the prevalence, diagnosis, and management of nocturia in OAB/BPH patients.

Results:

Based on the survey results, nocturia remains a significant yet often overlooked condition in patients with OAB/BPH across Asia. A substantial proportion of these patients experience at least two nocturnal voids, with 20–50% diagnosed with nocturnal polyuria (NP), underscoring the need for targeted treatment. The survey and discussion identified barriers among both patients and healthcare providers that lead to delayed diagnosis and inadequate management of nocturnal polyuria, including a focus on prioritization of treatment for OAB/BPH over that of nocturia. Patient barriers to desmopressin use include misperceptions that nocturia is a normal part of aging and reluctance to add another medication to their treatment regimens. Barriers among physicians include underestimation of the impact of nocturia on patients and greater familiarity with OAB/BPH medications than with desmopressin. Both patients and physicians are concerned about the burden of bladder diaries and the risk of hyponatremia.