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Assessment and treatment of nocturia in neurological disease in a primary care setting; systematic review and nominal group technique consensus

van Merode, Nadine AM; Dawson, Shoba; Coulthard, Elizabeth; Henderson, Emily J; Rice, Claire M; Rees, Jonathan; Smith, Matthew; Strong, Ed; Cotterill, Nikki; Huntley, Alyson L; Drake, Marcus J


Nadine AM van Merode

Shoba Dawson

Elizabeth Coulthard

Emily J Henderson

Claire M Rice

Jonathan Rees

Matthew Smith

Ed Strong

N Nikki Cotterill
Professor of Long Term Conditions (Continence Care)

Alyson L Huntley

Marcus J Drake


Context, Neurological disease can affect rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired.

Objective, Systematic review (SR) of nocturia in neurological diseases, and expert consensus for management in clinics without neurologist input.

Evidence Acquisition, Four databases were searched from January 2000-April 2020. 6262 titles and abstracts were screened and 43 studies were included for full-text screening. 11 met the inclusion criteria and two studies were identified through other sources. Nominal Group Technique (NGT) was used to develop consensus in an expert/ public panel.

Evidence Synthesis, 13 studies (seven Parkinson’s disease, five multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic floor muscle training, medications review, risk mitigation, improving bowel function, overactive bladder syndrome therapy (if urgency is reported in association with nocturia episodes), treatment of post void residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered.

Conclusion, Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed.

Patient Summary, People with neurological disease can suffer severe sleep disturbance from passing urine several times overnight. We looked at published research and found very little information to help general practitioners manage this. We assembled a group of experts, to develop practical approaches for assessing and treating nocturia in neurological disease.


van Merode, N. A., Dawson, S., Coulthard, E., Henderson, E. J., Rice, C. M., Rees, J., …Drake, M. J. (in press). Assessment and treatment of nocturia in neurological disease in a primary care setting; systematic review and nominal group technique consensus. European Urology Focus,

Journal Article Type Article
Acceptance Date Dec 28, 2021
Deposit Date Jan 14, 2022
Journal European Urology Focus
Publisher Elsevier
Peer Reviewed Peer Reviewed
Public URL