Are there potential new therapeutic avenues for treating idiopathic nocturia? ICI‐RS 2025

Background

Nocturia is a prevalent condition with systematic etiologies which require multidisciplinary collaborations during diagnosis and management. Here we evaluate current evidence and present unresolved research questions regarding the three key pathophysiological domains of nocturia with respect to a conceptual brain-kidney-bladder axis, namely sleep enhancement, extra-renal water reabsorption and circadian regulation of bladder tissue.

Methods

A Think Tank was convened at the 12th International Consultation on Incontinence Research Society meeting in June 2025, looking at novel therapeutic targets for nocturia. This article synthesizes key deliberations from this meeting session.

Results

The discussion was mainly focused on idiopathic nocturia with an overactive bladder symptom complex or nocturnal polyuria. Firstly, medications and conservative nondrug measures targeting sleep that could potentially improve nocturia were considered. Secondly, investigation of water reabsorption mechanisms within the bladder and the role of small molecule vasopressin receptor type-2 agonists were examined that may provide novel therapeutic options to rectify nocturnal polyuria. Finally, to address circadian misalignments, organ specific chronotherapies, based on abnormal circadian features of bladder tissues that can be curative for nocturia, were discussed.

Conclusions

The evidence indicates that promising therapeutic modalities targeting the regulation of sleep-wake cycles, intravesical water transport mechanisms, and circadian patterns of detrusor activity may offer alternative strategies for managing nocturnal polyuria. However, further mechanistic investigations and randomized controlled trials are required to advance these approaches toward clinical translation.