What is the most effective treatment for nocturia or nocturnal incontinence in adult women?

Dina Bedretdinova*, David Ambühl, Muhammad Imran Omar, Vasileios Sakalis, Nikesh Thiruchelvam, Marc Schneider, Arjun Nambiar, Ruud Bosch

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Context: Nocturia is a prevalent symptom with varied aetiology and no consensus on treatment options.

Objective:
We systematically reviewed evidence comparing the benefits and harms of various treatment options for nocturia or nocturnal incontinence in women.

Evidence acquisition:
Literature search was performed using Embase, Medline, Cochrane databases (from January 1, 1946 to September 26, 2017), following the methods detailed in the Cochrane Handbook. The protocol was registered with PROSPERO. Certainty of evidence was assessed with GRADE approach.

Evidence synthesis: The literature search identified 3573 citations, of which 11 full text articles were included. 3 studies on desmopressin and 4 on antimuscarinics provided evidence of improving nocturia symptoms. 4 studies on behavioural treatment provided limited evidence and controversial results. 1 study on oestrogen did not prove the benefit of any mode of administration, and one smallstudy on functional magnetic stimulation provided some evidence of effectiveness in nocturia. One RCT (141 participants) reported a statistically significant difference between the desmopressin and placebo group (desmopressin patients experienced 0.75 (95% CI 0.47-1.03) nocturia episodes less than placebo; certainty of evidence = low). The only RCT on antimuscarinics in women with nocturia reported oxybutynin reduced the number of nocturia episodes by 0.3 (95% CI -0.02 to 0.62) versus placebo. In one RCT comparing tolterodine to the combination of tolterodine with behavioural therapy, there was significant change from baseline nocturnal incontinence episodes in both groups.

Conclusions: 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.

Patient summary:
This review identified several medical treatments for nocturia in women, such as desmopressin and antimuscarinics, that appear to improve the severity of the condition.
Original languageEnglish
JournalEuropean Urology Focus
Early online date13 Feb 2020
DOIs
Publication statusE-pub ahead of print - 13 Feb 2020

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Keywords

  • Antimuscarinics
  • Desmopressin
  • Nocturia
  • Systematic Review
  • Treatment
  • Women

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