Treatment of overactive bladder in men: Is it really different?

Abstract

Introduction Overactive bladder (OAB) in men is a topic that is gaining increasing attention as there is a wider understanding that OAB is not a female condition. There are several treatments; however, data in male populations are lacking compared to female cohorts. The high likelihood of concomitant benign prostatic hyperplasia (BPH) and benign prostatic obstruction (BPO) adds to the complexity of the treatment algorithm. The overlap in urinary storage symptoms also makes the interpretation of the literature challenging. Methods Articles that evaluated men with OAB and men with OAB and BPH/BPO were evaluated and assessed. Results Behavioral interventions can offer a significant benefit to male patients with OAB. Medical therapies that have been studied in men with OAB include anticholinergics, beta‐3 agonists, and phosphodiesterase‐5 inhibits. These agents can be offered in addition to alpha‐blockers for men with coexisting BPH/BPO. The literature on Onabotulinumtoxin‐A and neuromodulation modulation in the male population is growing and shows promising results. Conclusion Male OAB is complex; however, there is a growing body of literature to help guide treatments. Many treatments are available and they have shown considerable success.

Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process

“…For all transition phases included, three classes of modifying factors were identified: anatomical factors, hormonal factors, and psychosocial factors. BPO‐associated LUTS, a characteristic of adulthood to elderly transition, exhibit considerable statistical association with OAB 32 and a divergence has emerged in dissociating both and separating the entities such by urodynamic parameters which define detrusor overactivity (DO) and bladder outlet obstruction 8 . The concept of lifelong OAB revisits this dynamic by suggesting that a background state of DO serves as a backdrop to which various anatomical factors, BPO among others, are added.…”

“…BPOassociated LUTS, a characteristic of adulthood to elderly transition, exhibit considerable statistical association with OAB 32 and a divergence has emerged in dissociating both and separating the entities such by urodynamic parameters which define detrusor overactivity (DO) and bladder outlet obstruction. 8 The concept of lifelong OAB revisits this dynamic by suggesting that a background state of DO serves as a backdrop to which various anatomical factors, BPO among others, are added. This framework extends to other factors, such as sexual trauma in the childhood, 33 metabolic syndrome with a T A B L E 4 Summary of statements of round 3.…”

“…Furthermore, the genitourinary syndrome of menopause is known to induce changes with OAB as a challenging part 7 . Benign prostatic obstruction (BPO), commonly observed in aging males, contributes to bladder dysfunction and can be the apparent cause of OAB symptoms, even affecting treatment approaches 8 . The coexistence and increasing prevalence of OAB and frailty as multidimensional syndromes with age highlights its lifelong characteristic as well 9 .…”

“…7 Benign prostatic obstruction (BPO), commonly observed in aging males, contributes to bladder dysfunction and can be the apparent cause of OAB symptoms, even affecting treatment approaches. 8 The coexistence and increasing prevalence of OAB and frailty as multidimensional syndromes with age highlights its lifelong characteristic as well. 9 Drawing on these findings, we propose the concept of lifelong OAB, which recognizes it as a persistent and continuous condition.…”

Management of complex OAB patients: A call to action

“…8 We provide a pragmatic approach to shared decision making and the tools to accomplish this in the review by Paudel and Lane. 9 The most clinically complex patients are those with overlapping lower urinary tract conditions, hence these are discussed thoroughly in Shapiro et al, 10 where the intersection of OAB and prostatic enlargement are explored. Bladder pain and OAB also have significant overlap and treatment approaches to these coexisting conditions are elaborated in the review by Dobberfuhl.…”