Medical management of lower urinary tract symptoms in men: current treatment and future approaches

Men with lower urinary tract symptoms frequently do not seek medical advice. For those who do, the traditional view of a solely prostatic origin might hinder management, since growing evidence suggests an important role for nonprostatic causes. This Review clarifies terminology for symptoms and causes and presents an overview of the available medical therapies. Lower urinary tract symptoms (LUTS) are extremely common in men and, in addition to causing considerable bother, can lead to the development of complications, such as acute urinary retention. Over the past couple of decades, developments in the medical management of LUTS in men have led to a substantial decline in the number of surgical procedures being performed to treat associated disorders, such as prostatectomy for benign prostatic enlargement. In this Review we summarize the available treatments and discuss the latest data on the use of anticholinergics and phosphodiesterase type-5 inhibitors for this indication. We also review the various combinations of medical therapies that have been reported in the literature to optimize the management of LUTS in men. In addition, there is a growing realization that LUTS in men are not synonymous with prostatic disease, and in many patients overactive bladder syndrome is the cause or a component of the LUTS experienced; we have, therefore, taken the opportunity to try to clarify the terminology used in LUTS in men, since there is the potential for considerable confusion with the terms that are currently in common usage in any discussion of this disorder. Key Points Although terminology regarding lower urinary tract symptoms (LUTS) in men and their underlying disorders has evolved, it remains confusing, and terms describing the nature of the LUTS (voiding or storage) might be more appropriate, particularly when the underlying diagnosis is unknown Improved understanding of the role of overactive bladder syndrome and storage symptoms in the etiology of LUTS in men has led to a paradigm shift away from the disorder being equated with prostatic disease or bladder outlet obstruction The aims of medical therapy for LUTS in men should be to improve the bothersome symptoms and/or reduce progression of the disease The availability of effective medical treatments for LUTS has led to a dramatic decline in the number of prostatectomies that are performed Enhanced understanding of the underlying causes of male LUTS has led to an interest in the role of anticholinergics