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Nocturia (the symptom) vs nocturnal polyuria (the condition)


‘Nocturia is a symptom, not a diagnosis’ 1

Nocturia, waking at night to void one or more times, is a common reason for nocturnal awakening.2,3 Waking up two or more times at night is considered to be bothersome to patients.4

Nocturia affects 60% of people over 70 years old and 17% of 20-40 year olds5

£1.35 BILLION is the estimated annual cost of managing nocturia and its consequences in the UK6

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Nocturia has been traditionally regarded by urologists as a urine storage symptom associated with bladder outlet obstruction (BOO) and/or overactive bladder (OAB).7

Studies show that nocturnal polyuria presents in 76-88% of reported cases – the majority of patients suffering from nocturia.7


In fact, patients who suffer from OAB or BOO with persistent nocturia despite treatment, may have underlying nocturnal polyuria regardless of gender, age, ethnicity or country.7


NP (the condition) — often the underlying cause of nocturia7


Nocturnal polyuria is defined as the production of abnormally large volumes of urine during sleep (>33% in elderly and >20% in younger patients of daily urine output).3 Arginine vasopressin (antidiuretic hormone or ADH), released from the brain, plays a key role in the control of urine production by increasing water absorption in the kidneys. This concentrates urine at night leading to decreased urine volumes during sleep.8 An insufficient level or absence of ADH at night can lead to large volumes of night-time urine production.8 This is due to reduced water absorption in the distal tubules and collecting ducts of the kidney.8



The potential for inadequate diagnosis in patients with NP is two-fold:7

  1. Some patients may be wrongly diagnosed with OAB or BOO (commonly secondary to benign prostatic hyperplasia [BPH])
  2. Some patients may have OAB or BOO with underlying NP




As NP is often the cause of nocturia, clinical recognition of the condition can offer improved diagnosis and treatment options to patients with nocturia.7


OAB and BOO medications do not specifically target nocturia caused by idiopathic NP, which means these patients may be suboptimally managed.


Noqdirna (oral lyophilisate desmopressin as acetate) is the only licensed medication for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults including patients over 65.10


An easy-to-use guide on how to differentiate OAB, BOO and NP to help find the right diagnosis for your patients suffering from nocturnal polyuria is downloadable here

  1. Matheson NW. BMJ 2004;328(7453):1438.
  2. Ohayon M et al. J Psychiatr Res 2008;43(1):48–54.
  3. van Kerrebroeck P et al. Neurourol Urodyn 2002;21:179–183.
  4. Everaert K et al. in Practical Functional Urology, Springer 2016. Edited by Heesakkers, et al. pp 377–392.
  5. Bosch JL & Weiss JP. J Urol 2013;189:S86–S92.
  6. Weidlich D et al. Eur J Health Econ 2017;18(6):761–771.
  7. Weiss JP et al. J Urol 2011;186:1358–1363.
  8. Weiss JP. Rev Urol 2012;14(3–4):48–55.
  9. Norgaard JP et al. Br J Urol 1997;79:825–835.
  10. Noqdirna Summary of Product Characteristics. May 2016. Available at: Date accessed: September 2017.

Job Code: UK-NOQD-2000015 - Date of preparation: January 2023


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