||Delphi assessment of nocturia
||The Evolution of our understanding of nocturia
||The dynamics of nocturia on a population basis
Jeffrey P. Weiss
The evolution of classification of nocturia as based upon systematic analysis of the frequency volume chart as well as comprehensive algorithm for diagnosis of the underlying medical conditions associated with nocturia will be discussed within the context of a number of illuminating case histories.
This is a consensus report based on the nocturia patient journey. The aims of the study are 1) Summarizing the nocturia patient pathway. 2) Picturing how nocturia is diagnosed and treated in the real world. 3) making a practical algorithm for treating Nocturia and focus on what has to be done before prescribing desmopressin.
Based on existing guidelines, consensus reports and gaps are filled through a Delphi process.
Causalities and their diagnostic and therapeutic packages are visualized and are based on urogynaecological, nephrological and/or endocrine causes, sleep disorders and/or cardiovascular and intake related causes. A risk management table for hyponatremia following desmopressin administration is suggested.
This work demonstrated the patient journey of people with nocturia, summarizes available consensus documents and guidelines and gives diagnosis and therapy a recognizable face.
Nocturia patient journey consensus group: Karel Everaert, Paul Abrams, Philip Van Kerrebroeck, Sherif Mourad, Chris Chapple, Marcus Drake, Hashim Hashim, Roger Dmochowski, Ruud Bosch, James N'dow and Alan Wein
Delphi Panel members: consensus group + Johan Vande Walle, Dudley Robinson, Adrian Wagg, Donald Bliwise, Jalesh Panicker, Marco Blanker, Ray Rosen, Kristian Juul Vinter, Jeff Weiss, Wendy Bower
Delphi facilitator: François Hervé
Knowledge about population prevalence, risk factors and outcomes of nocturia has accumulated in the past two decades. Recent, multi-national, epidemiologic studies have highlighted the role of: a) essential risk factors, b) correlates and comorbidities, and c) adverse outcomes and consequences of nocturia. Some general findings are as follows:
• Nocturia refers to waking at night to urinate, whereas nocturnal polyuria (NP) is defined as abnormal urine production. The two conditions overlap substantially.
• NP is a primary cause, although not the only causal factor in nocturia.
• Nocturia increases with age in both genders. Nocturia also has higher rates of adverse consequences and morbidities (falls etc) in the elderly. Some studies show association with mortality.
• Nocturia increases with comorbidities, depression and obesity; outcomes include depression and sleep disruption. Vicious cycle for chronic sufferers.
• High level of unmet medical need. No approved medication until recently, and lack of awareness in patients and physicians.