Best practice in the management of storage symptoms in male lower urinary tract symptoms: a review of the evidence base

Abstract

Storage lower urinary tract symptoms (LUTS) are characterized by an altered bladder sensation, increased daytime frequency, nocturia, urgency and urgency incontinence. Some evidence underlines the role of metabolic factors, pelvic ischemia, prostatic chronic inflammation and associated comorbidities in the pathophysiology of storage LUTS. A detailed evaluation of the severity of storage LUTS, and the concomitance of these symptoms with voiding and postmicturition symptoms, is mandatory for improving the diagnosis and personalizing treatment. A detailed medical history with comorbidities and associated risk factors, a physical examination, a comprehensive analysis of all the features of LUTS, including their impact on quality of life, and a frequency-volume chart (FVC) or bladder diary, are recommended for men with storage LUTS. Several drugs are available for the treatment of LUTS secondary to benign prostatic obstruction (BPO). Alpha-blockers (α-blockers), 5-α-reductase inhibitors and phosphodiesterase type 5 inhibitors are commonly used to manage storage LUTS occurring with voiding symptoms associated with BPO. Muscarinic receptor antagonists and Beta 3-agonists (β3-agonists) alone, or in combination with α-blockers, represent the gold standard of treatment in men with predominant storage LUTS. There is no specific recommendation regarding the best treatment options for storage LUTS after prostatic surgery.

Tadalafil 5 mg Alone or in Combination with Tamsulosin 0.4 mg for the Management of Men with Lower Urinary Tract Symptoms and Erectile Dysfunction: Results of a Prospective Observational Trial

“…Indeed, PDE5-Is are able to manage prostate inflammation and could act on the related fibrosis by improving pelvic and prostate oxygenation. Moreover, it seems that they might contribute to restore the physiologic activity of prostate and to stabilize the glandular structural anatomy [17,22,23].…”

Does Prostate Artery Embolization (PAE) Improve Voiding Symptoms, Storage Symptoms, or Both?

“…Storage symptoms often have a more complex and multifactorial causation when compared with voiding symptoms [8], and BPO occasionally is not the cause of storage symptoms. Radiologists therefore need to be aware that patients with only storage symptoms (rather than voiding and storage symptoms combined) may be due to other etiologies.…”

“…Formal urodynamics (with invasive bladder pressure monitoring) remain the gold-standard method of demonstrating bladder outflow obstruction. This investigation is therefore perhaps more relevant in patients with significant storage symptoms and minimal voiding symptoms, as other underlying etiologies can be the cause and need to be excluded [8].…”

Impact of early vs. delayed initiation of dutasteride/tamsulosin combination therapy on the risk of acute urinary retention or BPH-related surgery in LUTS/BPH patients with moderate-to-severe symptoms at risk of disease progression

“…Specifically, for men with moderate or severe LUTS at risk of disease progression, 5ARI with an α-blocker is an initial treatment of choice recommended by clinical guidelines [1]. Nevertheless, in clinical practice patients with moderate or severe LUTS at risk of disease progression continue to be treated initially with only an α-blocker [27]. Little attention has been given to the impact of variable disease progression rates on LUTS deterioration and subsequent implications for the risk of AUR/S following delayed initiation of 5ARIs [28,29].…”