Management of nocturia: A nosological entity within lower urinary tract symptoms in men [Prise en charge de la nycturie: Une entité nosologique au sein des troubles mictionnels de l'homme]

摘要

Aim: To review the definition, pathophysiology, impact and management of nocturia in men. Methods: We conducted a literature review using Medline and Embase with the following keywords: nocturia or nocturnal polyuria. Results: Nocturia in men is a multifactorial condition that may results from prostate but also kidney, bladder, heart, or lung diseases. It affects up to 60% of men over 70years and is responsible for major morbidity (sleep disorders, depression, falls, fractures), especially in the elderly. Pathophysiologically, we distinguish nocturia related to excessive urine production from those resulting from a reduction in the maximum voided volume. Thus, the first and most important workup is a frequency-volume chart conducted on a 72-hour-period. The initial assessment should then be continued to clearly identify the factors contributing to polyuria (disturbance of the pattern of endogenous production of arginine vasopressin, obstructive sleep apnea...) or to a reduction in the maximum voided volume (benign prostatic hyperplasia, overactive bladder). Treatment is then targeted: treatment of benign prostatic hyperplasia, antimuscarinic in case of overactive bladder, analogue of arginin vasopressin (demopressine) if nocturnal polyuria is involved, or continuous positive airway pressure in case of a sleep apnea syndrome. Conclusion: Nocturia is a common and serious condition due to its morbidity. Its understanding and management have evolved significantly in recent years and are now based on a multimodal approach.