How do you treat nocturia refractory to desmopressin?

If a patient has isolated nocturia, it's often not a urologic issue but can be a symptom of a sleep disorder or sleep apnea. If the patient has daytime OAB symptoms as well, then treat it may be time to try third line OAB treatment.

That can be a challenging question. I typically consider the diagnosis of primary nocturnal polyuria as the cause of nocturia, which can be treated with desmopressin as a diagnosis of exclusion. I would first recommend evaluating the patient with a voiding bladder diary to better understand overall hydration, a possible bladder storage problem, or only a nighttime overproduction problem. I would address behavioral factors like shifting fluids earlier in the day and minimizing high diuretic fluid...