Section Editor: Kevin T. McVary, MD, FACS

In 2002, the International Continence Society (ICS) defined nocturia as “waking up at night at least once to void,” however, clinically relevant nocturia is generally accepted among urologists to indicate two or more voids that are preceded and followed by sleep. Neither definition accounts for the patient’s degree of bother from nocturia, though waking twice or more from sleep to void has been associated with impaired quality of life. The economic burden of nocturia is substantial and includes injuries from falls, lost work productivity, and intangible losses such as distress, behavior changes, and confinements. The estimated financial impact is considerable, as indirect costs have been estimated in the tens of billions per year. There remain many unmet needs in the treatment of nocturia. It is arguably the most bothersome lower urinary tract symptom and necessarily imposes a considerable burden on quality of life. The often-multifactorial etiologies contributing to nocturia obscure the establishment of a reliable diagnosis.

As urologists, we focus on the genitourinary system and perhaps too often overlook the reality that nocturia may, in fact, be a pelvic expression of a holistic medical problem. The various types of nocturia (global, nocturnal polyuria, reduced bladder capacity, mixed) further cloud treatment options. We often fail to recognize nocturia as a unique disease or symptom complex requiring special concern and judicious evaluation. While there have been some hopeful advances in recent years, there continues to be a gaping need for more funded research on the management of nocturia. This Next Generation Nocturia Learning Center will aim to close the learning gaps and improve the knowledge deficits of through interactive, diverse, continuing educational content.


Management of Nocturia

Management of Nocturia: An Unmet Need in LUTS

Kevin T. McVary, MD, illustrates why nocturia is the leading lower urinary tract symptoms (LUTS) complaint that prompts men to seek out urological care.


Updates in LUTS: Treating Overactive Bladder and Nocturia

Mitchell R. Humphreys, MD, describes the shifting landscape of lower urinary tract symptoms (LUTS) management from a symptom-focused approach to a paradigm of altering the underlying disease progression. He focuses on changes in the medical management of nocturia and bladder outlet obstruction due to benign prostatic hyperplasia (BPH).

Optimizing the Diagnosis and Management of Nocturia

Neil H. Baum, MD, discusses the frequency and danger of falls and fractures in older Americans, noting that nocturia is a major cause. He emphasizes the important role urologists play in screening patients for falls, and explains the multifactorial nature of nocturia and corresponding treatment options, as well as how to manage patients’ comorbidities.
Prevalence of Nocturia in US Women

Prevalence of Nocturia in US Women

Timothy K. Byler, MD, discusses the significant quality of life impact associated with nocturia, as well as underlying diseases and causative factors. He then reviews findings on the epidemiology of nocturia and its prevalence in women in the United States.
New Treatment Options in LUTS

New Treatment Options in LUTS

Matt T. Rosenberg, MD, discusses treating of lower urinary tract symptoms (LUTS) through a framework of inhibiting overproduction of urine by the kidneys. In this dual-presentation, he describes behavioral modifications as well as pharmacologic agents for the management of overactive bladder (OAB) and nocturia.
Nocturia: Symptom or Disease?

Nocturia: Symptom or Disease?

Matt T. Rosenberg, MD, discusses the multiple etiologies of nocturia and nocturnal polyuria and corresponding treatment options, emphasizing the need for shared care when managing nocturia. He then reviews the efficacy and safety of a novel version of desmopressin for reducing the kidney’s production of urine at night time.

Future Directions in the Treatment of Nocturia

Matt T. Rosenberg, MD, reviews treatment options for nocturia, such as patient counseling, medications, and newly available molecules that can safely control urine excretion from the kidneys. He also discusses quality of life burden nocturia poses on patients, as well as differentiating between nocturia and nocturnal polyuria.


Kevin T. McVary, MD, FACS
Loyola University Medical Center
Maywood, Illinois

Dr. McVary is the Director, Center for Male Health, and the Professor of Urology at Stritch School of Medicine, Loyola University Medical Center. He is affiliated with multiple hospitals in the Springfield area, including Northwestern Memorial Hospital and St. John’s Hospital. His research interests include sexual dysfunction, prostate cancer, prostate disease, robotics, and BPH. He received his medical degree from Northwestern University Feinberg School of Medicine and has been in practice for more than 20 years.