Nocturia, which affects general health and quality of life, is a symptom often observed not only in patients with benign prostatic hyperplasia, but in the elderly of both genders as well. There are 5 causes of nocturia: (1) nocturnal polyuria, (2) reduction of nocturnal bladder capacity, (3) a combination of 1 and 2, (4) global polyuria, and (5) sleep disorders. To understand the pathogenesis of nocturia, it is important to investigate different factors for each cause. For nocturnal polyuria (1), it is important to investigate excessive fluid intake, hypertension, circadian rhythm of arginine vasopressin (AVP), and cardiovascular conditions based on brain natriuretic peptide (BNP) levels in plasma. For reduction of nocturnal bladder capacity (2), blood pressure and plasma concentrations of melatonin and glycine must be measured. Complicating systemic diseases such as diabetes mellitus, diabetes insipidus and polydipsia can lead to global polyuria (4), and sleep disorders (5) are defined by the quality of sleep, including conditions of arousal and hypnagogic disorders. The purpose of this article is to review the pathogenesis and diagnosis of nocturia, particularly by focusing on other causes than urological fields, which might lead to a better understanding of nocturia. To diagnose and make a therapeutic plan for nocturia, a modified bladder diary, International Prostate Symptom Score (IPSS), King’s Health Questionnaire (KHQ), Pittsburgh Sleep Quality Index (PSQI), and a sleeping diary are useful and should be combined with an interview and urological examination.
Keywords: Nocturia, Pathogenesis, Diagnosis
Correspondence: Hitoshi Oh-oka, Department of Urology, Independent Administrative Institution National Hospital Organization Kobe Medical Center 3-1-1, Nishi-Ochiai, Suma-ku, Kobe, Hyogo 654-0155, Japan,
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