Nocturia is a prevalent symptom with varied aetiology and no consensus on treatment options.
We systematically reviewed evidence comparing the benefits and harms of various treatment options for nocturia or nocturnal incontinence in women.
Literature search was performed using Embase, Medline, and Cochrane databases (from 1 January 1946 to 26 September 2017), following the methods detailed in the Cochrane Handbook. The protocol was registered with PROSPERO. Certainty of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
The literature search identified 3573 citations, of which 11 full-text articles were included. Three studies on desmopressin and four on antimuscarinics provided evidence of improving nocturia symptoms. Four studies on behavioural treatment provided limited evidence and controversial results. One study on oestrogen did not prove the benefit of any mode of administration, and one small study on functional magnetic stimulation provided some evidence of effectiveness in nocturia. One randomised controlled trial (RCT; 141 participants) reported a statistically significant difference between the desmopressin and placebo groups (desmopressin patients experienced 0.75 [95% confidence interval {CI} 0.47-1.03] nocturia episodes less than those experience by the placebo group; certainty of evidence = low). The only RCT on antimuscarinics in women with nocturia reported that oxybutynin reduced the number of nocturia episodes by 0.3 (95% CI -0.02 to 0.62) versus placebo. In one RCT comparing tolterodine with the combination of tolterodine with behavioural therapy, there was significant change from baseline nocturnal incontinence episodes in both groups.
There is some evidence that desmopressin and antimuscarinics are effective treatment options for nocturia; however, there is very limited evidence for other treatment options. The findings should be interpreted with caution as there were some methodological flaws in the included studies, particularly outcome heterogeneity.
This review identified several medical treatments for nocturia in women, such as desmopressin and antimuscarinics, which appear to improve the severity of the condition.
European urology focus. 2020 Feb 12 [Epub ahead of print]
Dina Bedretdinova, David Ambühl, Muhammad Imran Omar, Vasileios Sakalis, Nikesh Thiruchelvam, Marc Schneider, Arjun Nambiar, Ruud Bosch
INSERM CESP U1018, Villejuif, France. Electronic address: ., Department of Urology, University Hospital Bern, Inselspital Anna Seiler-Haus, Bern, Switzerland., European Association of Urology Guidelines Office, Arnhem, The Netherlands., Department of Urology, General Hospital of Thessaloniki Agios Pavlos, Thessaloniki, Greece., Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, UK., Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK., Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands.