A Shifted Paradigm for the Further Understanding, Evaluation, and Treatment of Lower Urinary Tract Symptoms in Men: Focus on the Bladder

• Published in: European urology 2006-04, Vol.49 (4), p.651-659
• Main Authors: Chapple, Christopher R., Roehrborn, Claus G.
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Antimuscarinics; Benign prostatic hyperplasia; Drug Therapy, Combination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Lower urinary tract symptoms; Male; Muscarinic Antagonists - therapeutic use; Overactive bladder; Prostatic Hyperplasia - complications; Tolterodine; Urinary Bladder Neck Obstruction - drug therapy; Urinary Bladder Neck Obstruction - etiology; Urinary Bladder Neck Obstruction - physiopathology; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - etiology; Urinary Bladder, Overactive - physiopathology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2006.02.018

Lower urinary tract symptoms (LUTS) are highly prevalent among older men and have a negative impact on health-related quality of life. Frequent comorbidity with potential prostatic disease adds complexity to the management of male LUTS. In this review, we discuss the pathophysiological conditions that underlie male LUTS, and examine the relationship between symptoms and urodynamic findings. The contribution of bladder dysfunction to male LUTS, with a particular emphasis on overactive bladder (OAB) symptoms, is explored. We also consider pharmacotherapeutic options for male LUTS. Pharmacotherapies that target the prostate (α1-receptor antagonists and 5α-reductase inhibitors) often fail to alleviate OAB symptoms, and may not be the most appropriate therapy for men with storage LUTS. Multiple studies have suggested that antimuscarinic therapy alone or in combination with α1-receptor antagonists improve OAB symptoms in men with and without bladder outlet obstruction. Although these agents may represent appropriate first-line therapies for men with OAB symptoms, the therapeutic potential of antimuscarinics alone or in combination with α1-receptor antagonists in this population should be evaluated in large-scale, well-designed clinical trials.