Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus

Nadine AM van Merode, Shoba Dawson, E J Coulthard, Emily J Henderson, Claire M Rice, Jonathan Rees, Matthew Smith, Edward Strong, Nikki Cotterill, Alyson L Huntley, Marcus J Drake*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Context
Neurological disease can affect the rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired.

Objective
To conduct a systematic review (SR) of nocturia in neurological diseases and achieve expert consensus for management in clinics without neurologist input.

Evidence acquisition
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 screening. Eleven of these met the inclusion criteria and two studies were identified through other sources. The nominal group technique (NGT) was used to develop consensus in panel comprising experts and public representation.

Evidence synthesis
Thirteen studies (seven in Parkinson’s disease, five in multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic-floor muscle training, review of medications, risk mitigation, improving bowel function, therapy for overactive bladder syndrome (if urgency is reported in association with nocturia episodes), treatment of postvoid residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered.

Conclusions
Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed.

Patient summary
People with a neurological disease can suffer severe sleep disturbance because of the need to pass urine several times overnight (called nocturia). We looked at published research and found very little information to help general practitioners in managing this condition. We assembled a group of experts to develop practical approaches for assessing and treating nocturia in neurological disease.
Original languageEnglish
Pages (from-to)33-41
Number of pages9
JournalEuropean Urology Focus
Volume8
Issue number1
Early online date12 Jan 2022
DOIs
Publication statusE-pub ahead of print - 12 Jan 2022

Bibliographical note

Funding Information:
Funding/Support and role of the sponsor: This project was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) programme (grant reference number NIHR RfPB PB-PG-1217-20034). The sponsor played no direct role in the study. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2021 European Association of Urology

Keywords

  • Nocturia
  • Nominal group technique
  • Lower urinary tract symptoms
  • Neurology
  • Systematic review

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