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Nocturia: Clinical presentation, diagnosis, and treatment

INTRODUCTION

Nocturia, a common symptom, is defined as waking at night to void, where each micturition is preceded and followed by sleep [1]. Although by definition even a single episode of awakening to urinate is nocturia, epidemiological evidence and expert clinical opinion both suggest nocturia is likely clinically meaningful if a patient voids two or more times nightly [2]. Patients themselves are more likely to consult a provider about nocturia if they have three or more episodes [3]. New onset adult nocturnal urinary incontinence or nighttime bed-wetting (enuresis) is rare and distinct from nocturia, and likely requires a different approach focusing on sleep problems or urinary obstruction [4,5].

Nocturia is a source of significant bother for some patients [6]. Nocturia is one of the most distressing symptoms in older men with benign prostatic hyperplasia (BPH) [7] and is the lower urinary tract symptom most strongly associated with poor quality of life ratings [8]. Patients report nocturia as a leading cause of sleep disturbance, affecting both sleep onset and maintenance [9]. Nocturia is associated with increased rates of depression [10], work absenteeism [11], lower self-rated physical and mental health [12], congestive heart failure [13], and increased all cause mortality [14]. In the very old, nocturia is associated with higher rates of accidental falls [15,16] and fractures [17,18].

Because nocturia is associated with a variety of clinical syndromes and disorders [19], the diagnostic approach is often challenging, and treatment may result in only small improvement [20].

This topic will discuss the clinical presentation, diagnosis, and treatment of nocturia in adults. Detailed discussions of some conditions that cause or are associated with nocturia are presented separately. (See "Diagnosis of polyuria and diabetes insipidus" and "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia" and "Approach to women with urinary incontinence".)

EPIDEMIOLOGY

The prevalence of nocturia is higher with increasing age [12,21-24]. Occasional nocturia is present in 50 percent of men and women aged 50 to 59 years. Among 18 to 49 year olds, more women than men have nocturia; the sex ratio reverses after 60 years of age, with prevalence greater in men than women [21]. The prevalence of twice nightly or greater nocturia among men between 70 and 79 is nearly 50 percent [21].

                                      

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Literature review current through: Nov 2014. | This topic last updated: Nov 20, 2014.
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References
Top
  1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21:5.
  2. Tikkinen KA, Johnson TM 2nd, Tammela TL, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol 2010; 57:488.
  3. Chen FY, Dai YT, Liu CK, et al. Perception of nocturia and medical consulting behavior among community-dwelling women. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:431.
  4. Sakamoto K, Blaivas JG. Adult onset nocturnal enuresis. J Urol 2001; 165:1914.
  5. Kramer NR, Bonitati AE, Millman RP. Enuresis and obstructive sleep apnea in adults. Chest 1998; 114:634.
  6. A comparison of quality of life with patient reported symptoms and objective findings in men with benign prostatic hyperplasia. The Department of Veterans Affairs Cooperative Study of transurethral resection for benign prostatic hyperplasia. J Urol 1993; 150:1696.
  7. DuBeau CE, Yalla SV, Resnick NM. Implications of the most bothersome prostatism symptom for clinical care and outcomes research. J Am Geriatr Soc 1995; 43:985.
  8. Van Dijk MM, Wijkstra H, Debruyne FM, et al. The role of nocturia in the quality of life of men with lower urinary tract symptoms. BJU Int 2010; 105:1141.
  9. Middelkoop HA, Smilde-van den Doel DA, Neven AK, et al. Subjective sleep characteristics of 1,485 males and females aged 50-93: effects of sex and age, and factors related to self-evaluated quality of sleep. J Gerontol A Biol Sci Med Sci 1996; 51:M108.
  10. van der Vaart CH, Roovers JP, de Leeuw JR, Heintz AP. Association between urogenital symptoms and depression in community-dwelling women aged 20 to 70 years. Urology 2007; 69:691.
  11. Asplund R, Henriksson S, Johansson S, Isacsson G. Nocturia and depression. BJU Int 2004; 93:1253.
  12. Fitzgerald MP, Litman HJ, Link CL, et al. The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol 2007; 177:1385.
  13. Siniorakis E, Kotsanis A, Kanderakis S, et al. Nocturia in males with heart failure: prostatic edema and circadian neurohormonal rhythm. Int J Cardiol 2008; 123:361.
  14. Kupelian V, Fitzgerald MP, Kaplan SA, et al. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol 2011; 185:571.
  15. Vaughan CP, Brown CJ, Goode PS, et al. The association of nocturia with incident falls in an elderly community-dwelling cohort. Int J Clin Pract 2010; 64:577.
  16. Stewart RB, Moore MT, May FE, et al. Nocturia: a risk factor for falls in the elderly. J Am Geriatr Soc 1992; 40:1217.
  17. Temml C, Ponholzer A, Gutjahr G, et al. Nocturia is an age-independent risk factor for hip-fractures in men. Neurourol Urodyn 2009; 28:949.
  18. Nakagawa H, Niu K, Hozawa A, et al. Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol 2010; 184:1413.
  19. van Kerrebroeck P, Abrams P, Chaikin D, et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21:179.
  20. Weiss JP, Blaivas JG. Nocturia. Curr Urol Rep 2003; 4:362.
  21. Tikkinen KA, Tammela TL, Huhtala H, Auvinen A. Is nocturia equally common among men and women? A population based study in Finland. J Urol 2006; 175:596.
  22. Liew LC, Tiong HY, Wong ML, et al. A population study of nocturia in Singapore. BJU Int 2006; 97:109.
  23. Lin TL, Ng SC, Chen YC, et al. What affects the occurrence of nocturia more: menopause or age? Maturitas 2005; 50:71.
  24. Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol 2013; 189:S86.
  25. Markland AD, Vaughan CP, Johnson TM 2nd, et al. Prevalence of nocturia in United States men: results from the National Health and Nutrition Examination Survey. J Urol 2011; 185:998.
  26. Kupelian V, Link CL, Hall SA, McKinlay JB. Are racial/ethnic disparities in the prevalence of nocturia due to socioeconomic status? Results of the BACH survey. J Urol 2009; 181:1756.
  27. Burgio KL, Johnson TM 2nd, Goode PS, et al. Prevalence and correlates of nocturia in community-dwelling older adults. J Am Geriatr Soc 2010; 58:861.
  28. Häkkinen JT, Hakama M, Shiri R, et al. Incidence of nocturia in 50 to 80-year-old Finnish men. J Urol 2006; 176:2541.
  29. Viktrup L. The risk of lower urinary tract symptoms five years after the first delivery. Neurourol Urodyn 2002; 21:2.
  30. Johnson TM 2nd, Sattin RW, Parmelee P, et al. Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults. J Am Geriatr Soc 2005; 53:1011.
  31. Tikkinen KA, Auvinen A, Johnson TM 2nd, et al. A systematic evaluation of factors associated with nocturia--the population-based FINNO study. Am J Epidemiol 2009; 170:361.
  32. van Doorn B, Kok ET, Blanker MH, et al. Mortality in older men with nocturia. A 15-year followup of the Krimpen study. J Urol 2012; 187:1727.
  33. Digesu GA, Khullar V, Panayi D, et al. Should we explain lower urinary tract symptoms to patients? Neurourol Urodyn 2008; 27:368.
  34. Hillier P, Knapp MS, Cove-Smith R. Circadian variations in urine excretion in chronic renal failure. Q J Med 1980; 49:461.
  35. Weiss JP, Wein AJ, van Kerrebroeck P, et al. Nocturia: new directions. Neurourol Urodyn 2011; 30:700.
  36. Vaughan CP, Johnson TM 2nd, Haukka J, et al. The fluctuation of nocturia in men with lower urinary tract symptoms allocated to placebo during a 12-month randomized, controlled trial. J Urol 2014; 191:1040.
  37. Mock LL, Parmelee PA, Kutner N, et al. Content validation of symptom-specific nocturia quality-of-life instrument developed in men: issues expressed by women, as well as men. Urology 2008; 72:736.
  38. Booth J, McMillan L. The impact of nocturia on older people - implications for nursing practice. Br J Nurs 2009; 18:592.
  39. Michel MC, Oelke M, Goepel M, et al. Relationships among symptoms, bother, and treatment satisfaction in overactive bladder patients. Neurourol Urodyn 2007; 26:190.
  40. Vaughan CP, Eisenstein R, Bliwise DL, et al. Self-rated sleep characteristics and bother from nocturia. Int J Clin Pract 2012; 66:369.
  41. Weiss JP, Blaivas JG. Nocturia. J Urol 2000; 163:5.
  42. van Doorn B, Kok ET, Blanker MH, et al. Determinants of nocturia: the Krimpen study. J Urol 2014; 191:1034.
  43. Chang SC, Lin AT, Chen KK, Chang LS. Multifactorial nature of male nocturia. Urology 2006; 67:541.
  44. Weiss JP, Blaivas JG, Jones M, et al. Age related pathogenesis of nocturia in patients with overactive bladder. J Urol 2007; 178:548.
  45. Vaughan CP, Endeshaw Y, Nagamia Z, et al. A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results. BJU Int 2009; 104:69.
  46. van Haarst EP, Heldeweg EA, Newling DW, Schlatmann TJ. The 24-h frequency-volume chart in adults reporting no voiding complaints: defining reference values and analysing variables. BJU Int 2004; 93:1257.
  47. Pfisterer MH, Griffiths DJ, Schaefer W, Resnick NM. The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc 2006; 54:405.
  48. Weiss JP, Blaivas JG, Stember DS, Chaikin DC. Evaluation of the etiology of nocturia in men: the nocturia and nocturnal bladder capacity indices. Neurourol Urodyn 1999; 18:559.
  49. Miller M. Nocturnal polyuria in older people: pathophysiology and clinical implications. J Am Geriatr Soc 2000; 48:1321.
  50. Kirkland JL, Lye M, Levy DW, Banerjee AK. Patterns of urine flow and electrolyte excretion in healthy elderly people. Br Med J (Clin Res Ed) 1983; 287:1665.
  51. George CP, Messerli FH, Genest J, et al. Diurnal variation of plasma vasopressin in man. J Clin Endocrinol Metab 1975; 41:332.
  52. Asplund R, Aberg H. Diurnal variation in the levels of antidiuretic hormone in the elderly. J Intern Med 1991; 229:131.
  53. Matthiesen TB, Rittig S, Nørgaard JP, et al. Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms. J Urol 1996; 156:1292.
  54. Suchowersky O, Furtado S, Rohs G. Beneficial effect of intranasal desmopressin for nocturnal polyuria in Parkinson's disease. Mov Disord 1995; 10:337.
  55. Hajduk IA, Strollo PJ Jr, Jasani RR, et al. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study. Sleep 2003; 26:61.
  56. Romero E, Krakow B, Haynes P, Ulibarri V. Nocturia and snoring: predictive symptoms for obstructive sleep apnea. Sleep Breath 2010; 14:337.
  57. Moriyama Y, Miwa K, Tanaka H, et al. Nocturia in men less than 50 years of age may be associated with obstructive sleep apnea syndrome. Urology 2008; 71:1096.
  58. Lowenstein L, Kenton K, Brubaker L, et al. The relationship between obstructive sleep apnea, nocturia, and daytime overactive bladder syndrome in women. Am J Obstet Gynecol 2008; 198:598.e1.
  59. Endeshaw YW, Johnson TM, Kutner MH, et al. Sleep-disordered breathing and nocturia in older adults. J Am Geriatr Soc 2004; 52:957.
  60. Pressman MR, Figueroa WG, Kendrick-Mohamed J, et al. Nocturia. A rarely recognized symptom of sleep apnea and other occult sleep disorders. Arch Intern Med 1996; 156:545.
  61. Fitzgerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol 2006; 194:1399.
  62. Umlauf MG, Chasens ER, Greevy RA, et al. Obstructive sleep apnea, nocturia and polyuria in older adults. Sleep 2004; 27:139.
  63. Krieger J, Laks L, Wilcox I, et al. Atrial natriuretic peptide release during sleep in patients with obstructive sleep apnoea before and during treatment with nasal continuous positive airway pressure. Clin Sci (Lond) 1989; 77:407.
  64. Häkkinen JT, Shiri R, Koskimäki J, et al. Depressive symptoms increase the incidence of nocturia: Tampere Aging Male Urologic Study (TAMUS). J Urol 2008; 179:1897.
  65. Kupelian V, Wei JT, O'Leary MP, et al. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol 2012; 61:78.
  66. Laven BA, Orsini N, Andersson SO, et al. Birth weight, abdominal obesity and the risk of lower urinary tract symptoms in a population based study of Swedish men. J Urol 2008; 179:1891.
  67. Barry MJ, Fowler FJ Jr, O'Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 1992; 148:1549.
  68. Abrams P, Klevmark B. Frequency volume charts: an indispensable part of lower urinary tract assessment. Scand J Urol Nephrol Suppl 1996; 179:47.
  69. Matzkin H, Greenstein A, Prager-Geller T, et al. Do reported micturition symptoms on the American Urological Association Questionnaire correlate with 24-hour home uroflowmetry recordings? J Urol 1996; 155:197.
  70. Blanker MH, Bohnen AM, Groeneveld FP, et al. Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men. J Urol 2000; 164:1201.
  71. Pedersen PA, Johansen PB. Prophylactic treatment of adult nocturia with bumetanide. Br J Urol 1988; 62:145.
  72. Reynard JM, Cannon A, Yang Q, Abrams P. A novel therapy for nocturnal polyuria: a double-blind randomized trial of frusemide against placebo. Br J Urol 1998; 81:215.
  73. Ouslander JG. Management of overactive bladder. N Engl J Med 2004; 350:786.
  74. Edwards KR, O'Connor JT. Risk of delirium with concomitant use of tolterodine and acetylcholinesterase inhibitors. J Am Geriatr Soc 2002; 50:1165.
  75. Katz IR, Sands LP, Bilker W, et al. Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride. J Am Geriatr Soc 1998; 46:8.
  76. Weiss JP. Nocturia: "do the math". J Urol 2006; 175:S16.
  77. Rembratt A, Norgaard JP, Andersson KE. Differences between nocturics and non-nocturics in voiding patterns: an analysis of frequency-volume charts from community-dwelling elderly. BJU Int 2003; 91:45.
  78. Fantl JA, et al.. Urinary incontinence in adults: Acute and chronic management. Clinical Practice Guideline No. 2, 1996 Update. AHCPR Publication NO. 96-0682, Agency for Health Care Policy and Research; Department of Health and Human Services, Rockville, MD 1996.
  79. Diokno AC, Brown MB, Goldstein NG, Herzog AR. Urinary flow rates and voiding pressures in elderly men living in a community. J Urol 1994; 151:1550.
  80. McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349:2387.
  81. Swithinbank L, Hashim H, Abrams P. The effect of fluid intake on urinary symptoms in women. J Urol 2005; 174:187.
  82. Hashim H, Abrams P. How should patients with an overactive bladder manipulate their fluid intake? BJU Int 2008; 102:62.
  83. Soda T, Masui K, Okuno H, et al. Efficacy of nondrug lifestyle measures for the treatment of nocturia. J Urol 2010; 184:1000.
  84. Johnson TM, Endeshaw Y, Nagamia Z, et al. A multicomponent intervention for nocturia in men. J Am Geriatr Soc 2005; 53:S94.
  85. Burgio KL. Current perspectives on management of urgency using bladder and behavioral training. J Am Acad Nurse Pract 2004; 16:4.
  86. Teunissen TA, de Jonge A, van Weel C, Lagro-Janssen AL. Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review. J Fam Pract 2004; 53:25.
  87. Burgio KL, Goode PS, Locher JL, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 2002; 288:2293.
  88. Burgio KL, Goode PS. Behavioral interventions for incontinence in ambulatory geriatric patients. Am J Med Sci 1997; 314:257.
  89. Johnson TM 2nd, Burgio KL, Redden DT, et al. Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc 2005; 53:846.
  90. Burgio KL, Goode PS, Johnson TM, et al. Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial. J Am Geriatr Soc 2011; 59:2209.
  91. Johnson TM 2nd, Markland AD, Goode PS, et al. Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia. BJU Int 2013; 112:100.
  92. Johnson TM 2nd, Jones K, Williford WO, et al. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. J Urol 2003; 170:145.
  93. Lepor H, Williford WO, Barry MJ, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 1996; 335:533.
  94. de Mey C, Michel MC, McEwen J, Moreland T. A double-blind comparison of terazosin and tamsulosin on their differential effects on ambulatory blood pressure and nocturnal orthostatic stress testing. Eur Urol 1998; 33:481.
  95. Roehrborn CG, Van Kerrebroeck P, Nordling J. Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU Int 2003; 92:257.
  96. Andersson KE. Storage and voiding symptoms: pathophysiologic aspects. Urology 2003; 62:3.
  97. Lepor H, Theune C. Randomized double-blind study comparing the efficacy of terazosin versus placebo in women with prostatism-like symptoms. J Urol 1995; 154:116.
  98. Johnson TM 2nd, Burrows PK, Kusek JW, et al. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J Urol 2007; 178:2045.
  99. Cho MC, Ku JH, Paick JS. Alpha-blocker plus diuretic combination therapy as second-line treatment for nocturia in men with LUTS: a pilot study. Urology 2009; 73:549.
  100. Cardozo L, Lisec M, Millard R, et al. Randomized, double-blind placebo controlled trial of the once daily antimuscarinic agent solifenacin succinate in patients with overactive bladder. J Urol 2004; 172:1919.
  101. Yokoyama O, Yamaguchi O, Kakizaki H, et al. Efficacy of solifenacin on nocturia in Japanese patients with overactive bladder: impact on sleep evaluated by bladder diary. J Urol 2011; 186:170.
  102. Ruggieri MR Sr, Braverman AS, Pontari MA. Combined use of alpha-adrenergic and muscarinic antagonists for the treatment of voiding dysfunction. J Urol 2005; 174:1743.
  103. Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 2006; 175:999.
  104. Kaplan SA, Walmsley K, Te AE. Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 2005; 174:2273.
  105. Malone-Lee JG, Walsh JB, Maugourd MF. Tolterodine: a safe and effective treatment for older patients with overactive bladder. J Am Geriatr Soc 2001; 49:700.
  106. Rackley R, Weiss JP, Rovner ES, et al. Nighttime dosing with tolterodine reduces overactive bladder-related nocturnal micturitions in patients with overactive bladder and nocturia. Urology 2006; 67:731.
  107. Kaplan SA, Roehrborn CG, Rovner ES, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 2006; 296:2319.
  108. Chapple CR, Cardozo L, Steers WD, Govier FE. Solifenacin significantly improves all symptoms of overactive bladder syndrome. Int J Clin Pract 2006; 60:959.
  109. Garely AD, Lucente V, Vapnek J, Smith N. Solifenacin for overactive bladder with incontinence: symptom bother and health-related quality of life outcomes. Ann Pharmacother 2007; 41:391.
  110. Wagg A, Wyndaele JJ, Sieber P. Efficacy and tolerability of solifenacin in elderly subjects with overactive bladder syndrome: a pooled analysis. Am J Geriatr Pharmacother 2006; 4:14.
  111. Cvetković RS, Plosker GL. Desmopressin: in adults with nocturia. Drugs 2005; 65:99.
  112. Asplund R, Aberg H. Diurnal rhythm of antidiuretic hormone in elderly subjects with nocturia. Med Sci Res 1991; 19:765.
  113. Moon DG, Jin MH, Lee JG, et al. Antidiuretic hormone in elderly male patients with severe nocturia: a circadian study. BJU Int 2004; 94:571.
  114. Rembratt A, Graugaard-Jensen C, Senderovitz T, et al. Pharmacokinetics and pharmacodynamics of desmopressin administered orally versus intravenously at daytime versus night-time in healthy men aged 55-70 years. Eur J Clin Pharmacol 2004; 60:397.
  115. Johnson TM, Burridge A, Issa MM, et al. The relationship between the action of arginine vasopressin and responsiveness to oral desmopressin in older men: a pilot study. J Am Geriatr Soc 2007; 55:562.
  116. Wang CJ, Lin YN, Huang SW, Chang CH. Low dose oral desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia: a double-blind, placebo controlled, randomized study. J Urol 2011; 185:219.
  117. Ebell MH, Radke T, Gardner J. A systematic review of the efficacy and safety of desmopressin for nocturia in adults. J Urol 2014; 192:829.
  118. Rembratt A, Norgaard JP, Andersson KE. Desmopressin in elderly patients with nocturia: short-term safety and effects on urine output, sleep and voiding patterns. BJU Int 2003; 91:642.
  119. Hvistendahl GM, Riis A, Nørgaard JP, Djurhuus JC. The pharmacokinetics of 400 microg of oral desmopressin in elderly patients with nocturia, and the correlation between the absorption of desmopressin and clinical effect. BJU Int 2005; 95:804.
  120. Weatherall M. The risk of hyponatremia in older adults using desmopressin for nocturia: a systematic review and meta-analysis. Neurourol Urodyn 2004; 23:302.
  121. Ljung R. Use of desmopressin and concomitant use of potentially interacting drugs in elderly patients in Sweden. Eur J Clin Pharmacol 2008; 64:439.
  122. Rembratt A, Riis A, Norgaard JP. Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia. Neurourol Urodyn 2006; 25:105.
  123. Chang YL, Lin AT, Chen KK. Short-term effects of desmopressin on water and electrolyte excretion in adults with nocturnal polyuria. J Urol 2007; 177:2227.
  124. Lose G, Mattiasson A, Walter S, et al. Clinical experiences with desmopressin for long-term treatment of nocturia. J Urol 2004; 172:1021.
  125. Mattiasson A, Abrams P, Van Kerrebroeck P, et al. Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men. BJU Int 2002; 89:855.
  126. Lose G, Lalos O, Freeman RM, et al. Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women. Am J Obstet Gynecol 2003; 189:1106.
  127. Weiss JP, Zinner NR, Klein BM, Nørgaard JP. Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. Neurourol Urodyn 2012; 31:441.
  128. Juul KV, Klein BM, Sandström R, et al. Gender difference in antidiuretic response to desmopressin. Am J Physiol Renal Physiol 2011; 300:F1116.
  129. Meyhoff HH, Nordling J. Long term results of transurethral and transvesical prostatectomy. A randomized study. Scand J Urol Nephrol 1986; 20:27.
  130. Homma Y. Classification of nocturia in the adult and elderly patient: a review of clinical criteria and selected literature. BJU Int 2005; 96 Suppl 1:8.
  131. Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol 2010; 183:1438.
  132. MacDiarmid SA, Peters KM, Shobeiri SA, et al. Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol 2010; 183:234.
  133. Drake MJ, Mills IW, Noble JG. Melatonin pharmacotherapy for nocturia in men with benign prostatic enlargement. J Urol 2004; 171:1199.
  134. Fu FG, Lavery HJ, Wu DL. Reducing nocturia in the elderly: a randomized placebo-controlled trial of staggered furosemide and desmopressin. Neurourol Urodyn 2011; 30:312.
  135. Fonda D, DuBeau CE, Hatari MD, et al. Incontinence in the frail elderly. In: Incontinence, Abrams P, Cardozo L, Khoury S, et al (Eds), Health Publications Ltd, Paris 2005.
  136. Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995; 273:1348.
  137. Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc 2000; 48:370.