Exciting New Resource For Nocturia Management

Key Messages

  • Nocturia is significantly associated with multiple health conditions and financial burden
  • Nocturia is more than just a lower urinary tract dysfunction
  • Assessment of nocturia must extend beyond the lower urinary tract, and cover broader health and behavioural issues
  • A new screening tool TANGO has been developed to identify clinically relevant co-morbidities

Dr Wendy Bower, physiotherapist and researcher at Royal Melbourne Hospital, is leading a research team in Australia, Europe and Asia, investigating nocturia, its multifactorial aetiology, and how to most effectively treat it.  They have developed a new screening tool TANGO, which aids the user in targeting the aetiology of nocturia and guiding individualised treatment.

Nocturia is commonly dismissed as a trivial condition, and a normal part of ageing.  However, recent research is revealing that the health and financial impact of nocturia is significant.  For example, nocturia is an independent predictor for early death, even when adjusted for age, gender, diabetes, smoking, coronary disease, renal disease, and stroke1.  

Sleep disturbances from nocturia result in impaired cognitive function, reduced mood, and increased risk of daytime falls.  Nocturia has also been associated with impaired glucose homeostasis and hypertension2.  Additionally, individuals with nocturia have three times the health care costs of those without3.  As more and more research is emerging about the impact of nocturia, we are learning it is not a trivial condition at all.

Nocturia: No Longer Considered A LUTS

Nocturia is now understood to be more complex than a lower urinary tract dysfunction4.  Dr Marcus Drake, an international leader in functional urology, published an editorial in European Urology in 2015 highlighting the multidimensional nature of nocturia4.  He discusses that patients presenting with nocturia often have broader health and/or behavioural issues unrelated to the lower urinary tract, and failing to identify these factors is dangerous.

TANGO – An Exciting New Tool

Dr Bower and her team have developed a new screening tool, TANGO: Targeting the Aetiology of Nocturia to Guide individualised treatment and improve Outcomes5.  The aim of the tool is to identify clinically relevant co-morbidities, which will in turn guide treatment direction. The TANGO tool has 23 questions over 4 domains:

  • Cardio / metabolic
  • Sleep
  • Urinary tract
  • Wellbeing

It is extremely easy to use, and directs the health care professional to which members of the multidisciplinary team require referral.  For example, if many sleep domains are ticked, referral to a sleep clinic is indicated, or if urinary tract domains are ticked, referral to pelvic floor physiotherapy is warranted.  As nocturia is a multifactorial condition, referral is recommended for each positive domain.

Access TANGO on our Referrer’s Resources page

How To Assess Nocturia

When evaluating nocturia, Dr Bower recommends screening for multifactorial etiology, and including patient reported outcomes in addition to frequency of nocturia.  

Her ideal assessment would include:

  1. TANGO screening tool – to identify clinically relevant co-morbidities
  2. Bladder diary – to assess lower urinary tract symptoms, total urine volume, nocturnal urine volume, nocturnal bladder capacity index
  3. Sleep assessment – including when the patient goes to sleep, when they first wake, number of times they wake, and how long they sleep for
  4. Clear interpretation of Solute levels
  5. Patient Reported Outcomes – such as the Nocturia Quality of Life Questionnaire (N-QOL)

Download our Bladder Diary on our Referrer’s Resources page

New Directions in Research

Dr Bower and her team are conducting ongoing research in this area, including effective treatments for nocturia and new medications, and will be publishing an article for GP’s about how to optimize management of nocturia in the near future.  Watch this space for exciting new developments!

References

1 Nakagawa, H., Niu, K., Hozawa, A., Ikeda, Y., Kaiho, Y., Ohmori-Matsuda, K., Nakaya, N.,
Kuriyama, S., Ebihara, S., Nagatomi, R., Tsuji, I., & Arai, Y.  Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. The Journal of Urology, 184(4), 1413-1418.
2 Endeshaw, Y. (2009). Correlates of self-reported nocturia among community-dwelling older adults. The J Gerontol Seri A: Biolog Sci Med Sci, 64, 142–8.
3 Nakagawa. H., Ikeda, Y., Kaiho, Y., et al. (2009). Impact of nocturia on medical care use and its costs in an elderly population: 30 month prospective observation of national health insurance beneficiaries in Japan. Proc Int Cont Soc, 80.
4 Drake, M. J. (2015). Should Nocturia Not Be Called a Lower Urinary Tract Symptom? European Urology, 67(2), 289–290.
5 Bower, W. F., Rose, G. E., Ervin, C. F., Goldin, J., Whishaw, D. M., & Khan, F. (2017). TANGO
– a screening tool to identify comorbidities on the causal pathway of Nocturia. BJU International, doi: 10.1111/bju.13774. [Epub ahead of print]