Evaluation and treatment of nocturia in neurological diseases in a primary care setting: systematic review and consensus on the nominal group technique

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Euro Urol Focus. 11 January 2022: S2405-4569(21)00323-0. doi: 10.1016/j.euf.2021.12.012. Online ahead of print.

ABSTRACT

BACKGROUND: Neurological diseases can affect the rate of urine output and bladder storage function, increasing the severity of nocturia, with additional risks if mobility or cognition is impaired.

OBJECTIVE: To conduct a systematic review (SR) of nocturia in neurological disease and achieve expert consensus for management in clinics without the involvement of a neurologist.

EVIDENCE COLLECTION: Four databases were searched from January 2000 to April 2020. A total of 6262 titles and abstracts were screened and 43 studies were included for full-text review. Eleven of these met the inclusion criteria and two studies were identified by other sources. The Nominal Group Technique (NGT) was used to develop consensus in a panel comprised of experts and public representation.

EVIDENCE SYNTHESIS: Thirteen studies (seven in Parkinson’s disease, five in multiple sclerosis) were included, all performed in secondary care. The severity of neurological disease was incompletely described and the severity of nocturia was generally measured subjectively. The NGT consensus supported basic neurological assessment and the use of bladder diaries when neurological impairment permits. Treatments include pelvic floor muscle training, medication review, risk mitigation, improvement of bowel function, therapy for overactive bladder syndrome (if ED reported in association with episodes of nocturia), treatment of post-void residuals and desmopressin as licensed. Measures to improve mobility and mitigate risks when using the toilet at night should be considered. Multifactorial problems such as obstructive sleep apnea and hypoventilation should be considered.

CONCLUSIONS: Nocturia in neurological disease is complex and lacks strong evidence, with very little research done in the primary care setting. Guidance should be pragmatic, with risk reduction being a key requirement, until a multidisciplinary database can be developed.

PATIENT SUMMARY: Individuals with a neurological condition may experience severe sleep disturbances due to the need to urinate multiple times during the night (called nocturia). We reviewed published research and found very little information to help GPs manage this condition. We have assembled a group of experts to develop practical approaches to assess and treat nocturia in neurological diseases.

PMID:35031351 | DOI:10.1016/j.euf.2021.12.012

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