Nocturia imposes a high burden on patients and healthcare systems through disrupted sleep, reduced quality of life, and increased risks of falls and mortality. Although nocturia is common in patients with overactive bladder (OAB) or benign prostatic hyperplasia (BPH), it has a distinct pathogenesis that is not addressed by medications for OAB or BPH. Desmopressin is the recommended pharmacological treatment, especially for patients with nocturnal polyuria. However, international data show that physicians often prioritize treating OAB/BPH over nocturnal symptoms, leading to inadequate management of nocturia. Herein, we describe local patterns in the diagnosis and management of nocturia in Asian countries and propose strategies to close gaps in patient care.

An international expert group, the Community of Nocturia Experts (CONE), comprising 13 urologists from Belgium, China, Hong Kong, India, Japan, Korea, Malaysia, Singapore, Taiwan, Thailand, and Vietnam, was convened to assess the burden of nocturia, review management guidelines, and examine regional clinical practices. A targeted literature review was conducted to gather data on epidemiology, treatment guidelines, and clinical challenges. Based on these findings, a 12-question online survey (refer to Table) was developed to assess the prevalence, diagnosis, and management of nocturia in OAB/BPH patients.

Based on the survey results, nocturia remains a significant yet often overlooked condition in patients with OAB/BPH across Asia. A substantial proportion of these patients experience at least two nocturnal voids, with 20–50% diagnosed with nocturnal polyuria (NP), underscoring the need for targeted treatment. The survey and discussion identified barriers among both patients and healthcare providers that lead to delayed diagnosis and inadequate management of nocturnal polyuria, including a focus on prioritization of treatment for OAB/BPH over that of nocturia. Patient barriers to desmopressin use include misperceptions that nocturia is a normal part of aging and reluctance to add another medication to their treatment regimens. Barriers among physicians include underestimation of the impact of nocturia on patients and greater familiarity with OAB/BPH medications than with desmopressin. Both patients and physicians are concerned about the burden of bladder diaries and the risk of hyponatremia.

Educational strategies have the potential to improve the diagnosis and management of nocturia in patients with OAB/BPH. We have outlined these strategies for both patients and healthcare professionals and offer suggestions to simplify diagnosis and patient monitoring.