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Incidence of nocturia in men with Lower Urinary Tract Symptoms associated with benign prostatic enlargement and outcomes after medical treatment: results from the evolution European Association of Urology research foundation prospective multinational registry

  • Sachin Malde,
  • Anup Patel,
  • Luis Martínez-Piñeiro,
  • Alexandre de la Taille,
  • Anders Bjartell,
  • Andrea Tubaro,
  • Wim Witjes,
  • Christien Caris

Publication: European Urology Focus, July 2019

Background

Nocturia is one of the most prevalent and bothersome lower urinary tract symptoms (LUTS) in men, leading to increased morbidity and mortality and a considerable economic burden on healthcare systems. Understanding its natural history, effect of pharmacotherapy, and predictors of failure of pharmacotherapy would allow optimised patient management.

Objective

To evaluate the prevalence and effect of clinically relevant nocturia (crN) on quality of life in a contemporary cohort of European men aged ≥50 yr in a “real-life” setting, to understand its natural history, to detect any effect of pharmacotherapy, and to identify predictors of pharmacotherapy failure.

Design, setting, and participants

This is a secondary analysis of the data from the Evolution Registry—a European, multicentre, prospective, observational registry, conducted in five European countries within a sample of general practitioners’ and urologists’ clinics. A consecutive sample of 2175 men aged ≥50 yr with LUTS in association with benign prostatic enlargement was enrolled between February 2010 and April 2011, and followed up for 2 yr. Overall, data from 1838 men were suitable for analysis.

Outcome measurements and statistical analysis

The primary outcome was evaluation of the baseline incidence of nocturia in the study population. Secondary outcomes included the impact of nocturia on quality of life, efficacy of pharmacotherapy, and predictive factors associated with persistence of nocturia. Descriptive statistics were used to examine the data. Logistic regressions were used to analyse associations between comorbid conditions and risk factors in men with nocturia.

Results and limitations

Overall, 1198 men (65%) reported crN (two or more voids per night). This increased age dependently from 59% in the 50–59-yr age group (n = 74) to 89% in the 80–99-yr age group (n = 25). Overall, the incidence of crN improved in those who commenced pharmacological treatment at study entry, from 69% at baseline to 49% at 24 mo (p < 0.00001). This was statistically significant only in those <80 yr old. A weak correlation was found between the severity of nocturia at baseline and quality-of-life scores on the International Prostate Symptom Score questionnaire (r = 0.33, p < 0.001). Of the patients treated with an alpha-blocker or a 5-alpha reductase inhibitor, 62% still had crN at 24 mo.

Conclusions

Almost two-thirds of men in the Evolution Registry reported clinically significant nocturia with increased incidence with age. Despite prostate-targeted treatment, most patients, especially older men, still had persistent or worsening nocturia at 2-yr follow-up, and in this study, it was not possible to identify specific clinical factors that predicted those who could respond well to treatment in this regard.

Patient summary

This large study of men from five different European countries has shown that waking up at night to pass urine (nocturia) is very common and becomes more common with older age, and treatments that target the prostate do not significantly improve symptoms over 2 yr in most men.

Commented by Dr. Rahnama'i

This study among 1198 men with bph has shown that about 65% have nocturia (defined as 2 or more voids per night) which increases with age. From the patients treated with an alpha-blocker or a 5-alpha reductase inhibitor, 62% still had nocturia after two years follow up. This underlines the fact that in the majority of cases prostate targeted treatments will not have a significant effect on nocturia. It is once again shown that the diagnosis and treatment of nocturia is more complex than simply treating the bph component. Patient history and bladder diaries will remain the mainstay of diagnostic and determin the therapy choice in patients with nocturia.