Volume 208 - Issue 10
Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder
Author: Eric Chung
Med J Aust 2018; 208 (10): 462. || doi: 10.5694/mja18.00238
Published online: 4 June 2018
Published online: 4 June 2018
In reply
In reply:
I thank Martin and colleagues for the letter on our article.1 While the International Continence Society defines overactive bladder (OAB) as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of a urinary tract infection or other obvious pathology;2 it is generally agreed upon that nocturia is more than just a problem relating to bladder storage and can often be multifactorial in nature.3 In fact, nocturnal voiding dysfunction can be caused by any conditions that contribute to global polyuria, nocturnal polyuria, decreased functional bladder capacity and primary sleep disorders.
Nocturia secondary to sleep disorders would be causatively different from nocturia secondary to pressure to urinate in common medical disorders and, therefore, would require different diagnostic procedures and treatment strategies. The association between obstructive sleep apnea (OSA) and nocturia has been extensively reported in the literature4 and authors agree that in some cases, the treatment of OSA will improve quality of sleep and decrease nocturnal voiding episodes. However, not all patients with OSA will have nocturnal voiding dysfunction,5 and the role of renal function profiles (water and/or sodium excretion at night), changes in circadian rhythms especially at night time, or behavioural-sleep disorders (eg, periodic limb movements during sleep and habitual voiding as a response to awakening) may play an equally important role too.6
We believe that we have provided a fair and balanced view on our position statement1 regarding the management of OAB. Understanding the complex interplay of various pathophysiological factors that contribute to OAB (including nocturia) is important for clinicians to make an informed decision about the most suitable treatment options for their patients based on their needs and circumstances.
Competing interests
No relevant disclosures.
References
- Chung E, Lee D, Gani J, et al. Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder. Med J Aust 2018; 208: 41-45.
- Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167-178.
- Van Kerrebroeck P, Andersson KE. Terminology, epidemiology, etiology and pathophysiology of nocturia. Neurourol Urodyn 2014; 33: S2-S5.
- Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol 2010; 184: 440-446.
- Bliwise DL, Dijk DJ, Juul KV. Nocturia is associated with loss of deep sleep independently from sleep apnea. Neurourol Urodyn 2015; 34: 392.
- Chung E. Desmopressin and nocturnal voiding dysfunction: clinical evidence and safety profile in the treatment of nocturia. Expert Opin Pharmacother 2018; 19: 291-298.