Patients with nocturia often experience delays or misdiagnosis before receiving proper treatment. Tailored guidance specific to the Malaysian context, especially in resource-limited settings, is essential for effectively treating nocturia. This local consensus aims to establish practical definitions, standardised methods for diagnosing and managing nocturia, and a simple algorithm for the use of desmopressin in adults.

A literature review was conducted to identify clinical publications on nocturia diagnosis and treatment from 2010 to 2023. Thirty-five statements were developed by a panel of local expert urologists using the Delphi method over three rounds of voting, with reference to the International Continence Society . For statements lacking consensus, the GRADE-ADOLOPMENT method was used.

Definitions: Experts reached a consensus on defining nocturia and nocturnal polyuria. Nocturia is considered bothersome when it involves ≥2 awakenings per night, particularly if impacting sleep and quality of life. Diagnosis: Recommended assessments include history-taking, physical examination, and essential clinical workups. A bladder diary is essential at the first clinical presentation. For older men, additional evaluations such as blood pressure measurement, digital rectal examination, and post-void residual urine measurement may be necessary. The TANGO-SF questionnaire is recommended alongside bladder diary for capturing nocturia's multifaceted nature and comorbidities. Management: Treatment includes lifestyle modifications and pharmacotherapy tailored to individual needs. Special caution is advised for patients with heart failure and frailty. Sex-specific dosing of desmopressin is recommended for nocturia due to nocturnal polyuria, with baseline serum sodium levels ≥135 mmol/L before initiation. Serum sodium levels should be monitored during treatment and adjusted as necessary.

Consensus was reached on practical definitions and standardized methods for diagnosing and managing nocturia in Malaysia, which is also applicable to other resource-limited settings.