Nocturia is a prevalent, multifactorial lower urinary tract symptom (LUTS) with significant impact on quality of life and increased morbidity, especially among the elderly. 
Despite its clinical relevance, it is often underdiagnosed and poorly addressed in routine practice. 
As first-line care providers, general practitioners (GPs) are well-positioned to screen, investigate, and initiate management, yet their awareness and practices in this area are not well defined.
This study aimed to assess GP knowledge, confidence, diagnostic practices, and referral behaviors regarding nocturia in diverse European settings. It also explored how these aspects relate to experience and clinical environment.

An online cross-sectional survey was distributed to general practitioners across multiple European countries through the Young Academic Urologists (YAU) group of the European Association of Urology (EAU), section Functional Urology. 
The questionnaire included demographic data, questions on perceived knowledge, comfort in managing nocturia, frequency of patient encounters, diagnostic methods, and referral patterns. Results were analyzed using descriptive statistics and bivariate comparisons.

A total of 65 responses were retrieved.
Descriptive information of the responders are described in Table 1.

When asked to estimate the prevalence of nocturia of ≥2 voids/night in adults over 60 years, most GPs (n = 49, 76.9%) selected between 16–50%, demonstrating overall awareness. 
While overactive bladder (92.3%, n=60) and dietary/fluid intake (90.8%, n= 59) were the most frequently identified causes of nocturia, other potential contributors were less commonly cited. Table 2
Only 27.7% rated their knowledge of nocturia management as relatively good (score 4/5), and 
none as excellent (score 5). Most (61.5%) reported moderate knowledge (score 3), paralleled by similar levels of comfort (56.9% moderately confident). Among GPs who declared good knowledge (score ≥4), 84.2% routinely used diagnostic tools like urinalysis or voiding diaries, compared to only 47.6% of those with lower knowledge (p < 0.05).

Only 23,1% of GPs (n = 15) noted that nocturia was mentioned spontaneously by patients. Voiding diaries were used by less than half of the respondents, (46.2%, n = 30).
Blood tests were used by 50.8% (n = 33) and urinalysis by 76.9% (n = 50), making them the most commonly employed diagnostic tools. 
Referral was most frequently made to urologists, (67.7%, n = 44) and referrals to sleep specialists and neurologists were rare, reported by only 3.1% (n = 2) and 4.6% (n = 3) of GPs, respectively.

Most GPs (75.4%) were willing to provide a voiding diary to referred patients, with lack of knowledge, lack of access and lack of time being the main reasons for not using this tool.

These results suggest that although the urological and lifestyle-related origins of nocturia are well known among GPs, awareness of systemic and multifactorial etiologies remains more variable. 
A clear gap exists between knowledge and implementation, especially regarding non-urological causes and interdisciplinary referrals. 
Voiding diaries are underutilized despite their recognized utility.

Despite being frequently encountered in clinical practice, nocturia remains underprioritized in primary care. 
Educational efforts and access to simple tools like voiding diaries may enhance GP confidence, diagnostic accuracy, and ultimately improve patient outcomes.

Everaert K, Hervé F, et al. The underestimation and undertreatment of nocturia: a multifactorial condition with major impact. Neurourol Urodyn. 2022;41(1):18–27.
Weiss JP. Nocturia: the need for a greater awareness. Nat Rev Urol. 2011;8(3):139–145.