Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men

Abrams, Paul; Chapple, Christopher R.; Khoury, S; Roehrborn, Claus G.; Rosette, Jean de la

doi:10.1016/j.juro.2008.11.127

Cited by 198 publications

(168 citation statements)

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“…1,2,3 It is one of the most common causes of lower urinary tract symptoms (LUTS) in men and starts after the age of 50 and by the age of 60 years 50% of men have histological evidence of BPH. 4 The Important recommended tool used in the evaluation of patients with BPH is American Urological Association (AUA) symptom score questionnaire that determine the severity of urinary symptoms, extent of the problems due to symptoms and level of quality of life due to urinary problems.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams

Joshi

Jong

Karmacharya

et al. 2015

Kathmandu Univ. Med. J.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams

Joshi

Jong

Karmacharya

et al. 2015

Kathmandu Univ. Med. J.

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“…3,4 Finally, the recommendations of the International Scientific Committee (ISC) on the Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men were published in 2009. 5 …”

Section: What Are the Most Recent Relevant Guidelines?mentioning

confidence: 99%

“…Figure 1 shows the algorithm presented in the ISC recommendations (2009). 5 The following is a review of the recommended pharmacologic treatment options. Surgical interventions are addressed in another section of this supplement.…”

Section: Pharmacologic Optionsmentioning

confidence: 99%

Benign prostatic hyperplasia and lower urinary tract symptom guidelines

Roehrborn

2013

CUAJ

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Lower urinary tract symptoms (LUTS) are very common in men, with incidence increasing with age. Several clinical practice guidelines are available as decision-making aids for men with LUTS and the recommendations are based on the presumed etiology of the symptoms (due to obstruction, overactive bladder or a combination of the two). This review presents the various pharmacologic treatment options and summarizes key clinical trial data supporting their use. L ower urinary tract symptoms (LUTS) are very common in men, with an increase in prevalence correlating with increasing age in a linear manner.1 Approximately 50% of men over the age of 50 have histological benign prostatic hyperplasia (BPH) and approximately 25% of men over 50 have moderate-to-severe LUTS. Clearly, not all men with BPH develop LUTS. In addition, not all men with LUTS have BPH as the underlying cause.For clinicians who treat LUTS in men, there are several relevant clinical practice guidelines that are available to help guide management decisions. This review will focus on the guideline recommendations with respect to pharmacotherapies, and include highlights of the key clinical trial evidence supporting the inclusion of these therapies among the recommended management options. What are the most recent, relevant guidelines?The most recent evidence-based recommendations in this field are the 2012 Guidelines on the Management of Male LUTS, published by the European Association of Urology (EAU).2 The American Urological Association (AUA) and the United Kingdom's National Institute for Health and Clinical Excellence (NICE) published guidelines for BPH and male LUTS, respectively, in 2010. Pharmacologic optionsEach of the published guidelines mentioned above recommend the use of several different pharmacotherapies for the treatment of LUTS, depending on the clinical situation. Figure 1 shows the algorithm presented in the ISC recommendations (2009).5 The following is a review of the recommended pharmacologic treatment options. Surgical interventions are addressed in another section of this supplement. AntimuscarinicsAntimuscarinics can be used to treat men with symptoms consistent with overactive bladder (OAB) and no bladder outlet obstruction (BOO), or those with mixed symptoms suggestive of combined BOO and OAB pathology. The data supporting this recommendation are primarily from studies investigating tolterodine. For example, in a post-hoc analysis of men with BOO and confirmed detrusor overactivity included in two studies, there was a significant reduction in frequency of urgency-related micturition.6 However, at present there is a lack of prospective data from longer-term studies for the use of antimuscarinics in patients at risk (i.e., larger glands and higher residual urine at baseline). Alpha-blockersThe evidence base is much more compelling for the use of alphablockers for men with BOO. For those men with smaller prostates and/or low prostate-specific antigen (PSA), the guidelines recommend monotherapy with an alpha-blocker as the ...

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“…4 A symptom score such as the International Prostate Symptom Score (IPSS) is not a diagnostic test, but is of value in quantifying the level of a patient's symptoms and can be valuable in measuring change in the condition after treatment or over a period of time off treatment. If size matters -as it appears to do -a prostate-specific antigen (PSA) test as a proxy for volume may be useful in the management of benign prostatic disease.…”

Section: Initial Management Of Male Lutsmentioning

confidence: 99%