Advertisement

Evaluation and Medical Management of BPH and LUTS in Men

  • Bilal Chughtai
  • Richard Lee
  • Matthew Hall
  • Alexis E. TeEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Lower urinary tract symptoms (LUTS) is a common diagnosis among the aging population. Symptoms are classified either obstructive (hesitancy, weak stream, straining, and prolonged voiding), irritative (frequency, urgency, nocturia, urge incontinence, and voiding small volumes), or postmicturation (postvoid dribble, incomplete emptying). Most patients present with a combination of these symptoms. Multiple etiologies may underlie these symptoms including benign prostatic hyperplasia (BPH), extrinsic compression, prior pelvic surgery, pelvic radiotherapy, urethral stricture, and medications. We discuss the natural history, management, and treatment of BPH-related LUTS with medical management.

Keywords

Benign Prostatic Hyperplasia Lower Urinary Tract Symptom Prostate Volume International Prostate Symptom Score Acute Urinary Retention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Roehrborn CG. Etiology, pathophysiology, epidemiology and natural history of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell’s urology. 9th ed. Amsterdam: Elsevier.Google Scholar
  2. 2.
    Oishi K, Boyle P, Barry M. Epidemiology and natural history of benign prostatic hyperplasia. In: Fourth international consultation on benign prostatic hyperplasia. Plymouth: Plymbridge Distributors Ltd; 1998. p. 23.Google Scholar
  3. 3.
    Girman CJ. Natural history and epidemiology of benign prostatic hyperplasia: relationship among urologic measures. Urology. 1998;51:8.PubMedCrossRefGoogle Scholar
  4. 4.
    Roehrborn CG. The utility of serum prostatic-specific antigen in the management of men with benign prostatic hyperplasia. Int J Impot Res. 2008;20 Suppl 3:S19.PubMedCrossRefGoogle Scholar
  5. 5.
    Bohnen AM, Groeneveld FP, Bosch JL. Serum prostate-specific antigen as a predictor of prostate volume in the community: the Krimpen study. Eur Urol. 2007;51:1645.PubMedCrossRefGoogle Scholar
  6. 6.
    Lieber MM, Jacobsen SJ, Roberts RO, et al. Prostate volume and prostate-specific antigen in the absence of prostate cancer: a review of the relationship and prediction of long-term outcomes. Prostate. 2001;49:208.PubMedCrossRefGoogle Scholar
  7. 7.
    Roehrborn CG, Boyle P, Gould AL, et al. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology. 1999;53:581.PubMedCrossRefGoogle Scholar
  8. 8.
    Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006; 354:557.PubMedCrossRefGoogle Scholar
  9. 9.
    Forray C, Bard J, Wetzel J, et al. The alpha 1-adrenergic receptor that mediates smooth muscle contraction in human prostate has the pharmacological properties of the cloned human alpha 1c subtype. Mol Pharmacol. 1994;1994:4.Google Scholar
  10. 10.
    Krane R, Olsson C. Phenoxybenzamine in neurogenic bladder dysfunction: I. A theory of micturition. J Urol. 1973;110:650.PubMedGoogle Scholar
  11. 11.
    Nordling J, Meyhoff H, Hald T. Sympatholytic effect on striated urethral sphincter. Scand J Urol Nephrol. 1981;15:173.PubMedCrossRefGoogle Scholar
  12. 12.
    McNaughton-Collins M, Barry MJ. Managing patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Am J Med. 2005;118:1331.PubMedCrossRefGoogle Scholar
  13. 13.
    Kirby RS, Coppinger SW, Corcoran MO, et al. Prazosin in the treatment of prostatic obstruction. A placebo-controlled study. Br J Urol. 1987;60:136.PubMedCrossRefGoogle Scholar
  14. 14.
    Chapple CR, Christmas T, Milroy EJ. A 12-week placebo-controlled double-blind study of prazosin in the treatment of prostatic obstruction due to benign prostatic hyperplasia. BJU Int. 1992;70:285.Google Scholar
  15. 15.
    Kirby RS, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell’s urology. 9th ed. Amsterdam: Elsevier.Google Scholar
  16. 16.
    Lepor H, Auerbach S, Puras-Baez A, et al. A randomized, placebo-controlled multicenter study of the efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia. J Urol. 1992;148:1467.PubMedGoogle Scholar
  17. 17.
    Chapple C, Carter P, Christmas T, et al. A three-month double-blind study of doxazosin as treatment for benign prostatic obstruction. BJU Int. 1994;74:50.CrossRefGoogle Scholar
  18. 18.
    Fawzy A, Braun K, Lewis GP, et al. Doxazosin in the treatment of benign prostatic hyperplasia in normotensive patients: a multicenter study. J Urol. 1995;154:105.PubMedCrossRefGoogle Scholar
  19. 19.
    Gillenwater JY, Conn RL, Chrysant SG, et al. Doxazosin for the treatment of benign prostatic hyperplasia in patients with mild to moderate essential hypertension: a double-blind, placebo-controlled, dose–response multicenter study. J Urol. 1995;154:110.PubMedCrossRefGoogle Scholar
  20. 20.
    Lepor H. Phase III multicenter placebo-controlled study of tamsulosin in benign prostatic hyperplasia. Tamsulosin Investigator Group. Urology. 1998; 51:892.PubMedCrossRefGoogle Scholar
  21. 21.
    Narayan P, Tewari A. A second phase III multicenter placebo controlled study of 2 dosages of modified release tamsulosin in patients with symptoms of benign prostatic hyperplasia. United States 93-01 Study Group. J Urol. 1998;160:1701.PubMedCrossRefGoogle Scholar
  22. 22.
    Roehrborn CG, Van Kerrebroeck P, Nordling J. Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU Int. 2003;92:257.PubMedCrossRefGoogle Scholar
  23. 23.
    Kawabe K, Yoshida M, Homma Y. Silodosin, a new alpha1A-adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men. BJU Int. 2006;98:1019.PubMedCrossRefGoogle Scholar
  24. 24.
    Yamanishi T, Mizuno T, Tatsumiya K, et al. Urodynamic effects of silodosin, a new alpha 1A-adrenoceptor selective antagonist, for the treatment of benign prostatic hyperplasia. Neurourol Urodyn. 2010;29:558.PubMedGoogle Scholar
  25. 25.
    Marks LS, Gittelman MC, Hill LA, et al. Rapid efficacy of the highly selective alpha1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies. J Urol. 2009;181:2634.PubMedCrossRefGoogle Scholar
  26. 26.
    Malloy BJ, Price DT, Price RR, et al. Alpha1-adrenergic receptor subtypes in human detrusor. J Urol. 1998;160:937.PubMedCrossRefGoogle Scholar
  27. 27.
    Garimella PS, Fink HA, Macdonald R, et al. Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2009;CD007360.Google Scholar
  28. 28.
    Coffey D, Walsh P. Clinical and experimental studies of benign prostatic hyperplasia. Urol Clin North Am. 1990;17:461.PubMedGoogle Scholar
  29. 29.
    Shapiro E. Embryologic development of the prostate. Urol Clin North Am. 1990;17:487.PubMedGoogle Scholar
  30. 30.
    Cabot A. The question of castration for enlarged prostate. Ann Surg. 1896;24:265.PubMedCrossRefGoogle Scholar
  31. 31.
    White J. The results of double castration in hypertrophy of the prostate. Ann Surg. 1895;22:1.PubMedCrossRefGoogle Scholar
  32. 32.
    Caine M, Perlberg S, Gordon R. The treatment of benign prostatic hypertrophy with flutamide (SCH: 13521): a placebo-controlled study. J Urol. 1975; 114:564.PubMedGoogle Scholar
  33. 33.
    Donkervoort T, Zinner NR, Sterling AM, et al. Megestrol acetate in treatment of benign prostatic hypertrophy. Urology. 1975;6:580.PubMedCrossRefGoogle Scholar
  34. 34.
    Schroeder FH, Westerhof M, Bosch RJ, et al. Benign prostatic hyperplasia treated by castration or the LH-RH analogue buserelin: a report on 6 cases. Eur Urol. 1986;12:318.PubMedGoogle Scholar
  35. 35.
    APG Committee. AUA guideline on management of benign prostatic hyperplasia. Chapter 1: diagnosis and treatment recommendations. J Urol. 2003;170(2 Pt 1):530.Google Scholar
  36. 36.
    Gormley GJ, Stoner E, Bruskewitz RC, et al. The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group. N Engl J Med. 1992;327:1185.PubMedCrossRefGoogle Scholar
  37. 37.
    Andersen J, Ekman P, Wolf H, et al. Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo controlled study. Urology. 1995;46:631.PubMedCrossRefGoogle Scholar
  38. 38.
    Marberger M. Long-term effects of finasteride in patients with benign prostatic hyperplasia: a double-blind, placebo-controlled, multicenter study. Urology. 1998;51:677.PubMedCrossRefGoogle Scholar
  39. 39.
    Stoner E. Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology. 1994;43:284.PubMedCrossRefGoogle Scholar
  40. 40.
    McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. 1998;338:557.PubMedCrossRefGoogle Scholar
  41. 41.
    Roehrborn CG, Lukkarinen O, Mark S, et al. Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies. BJU Int. 2005;96:572.PubMedCrossRefGoogle Scholar
  42. 42.
    Fenter TC, Davis EA, Shah MB, et al. Dutasteride vs finasteride: assessment of differences in acute urinary retention rates and surgical risk outcomes in an elderly population aged > or =65 years. Am J Manag Care. 2008;14:S154.PubMedGoogle Scholar
  43. 43.
    Anderson KE. Pharmacology of lower urinary tract smooth muscles and penile erectile tissues. Pharmacol Rev. 1993;45:253.PubMedGoogle Scholar
  44. 44.
    Kaplan SA, Roehrborn CG, Rovner ES, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006;296:2319.PubMedCrossRefGoogle Scholar
  45. 45.
    Abrams P, Kaplan S, De Koning Gans HJ, et al. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol. 2006;175:999.PubMedCrossRefGoogle Scholar
  46. 46.
    Martin-Merino E, Garcia-Rodriguez LA, Masso-Gonzalez EL, et al. Do oral antimuscarinic drugs carry an increased risk of acute urinary retention? J Urol. 2009;182:1442.PubMedCrossRefGoogle Scholar
  47. 47.
    Li MK, Garcia LA, Rosen R. Lower urinary tract symptoms and male sexual dysfunction in Asia: a survey of ageing men from five Asian countries. BJU Int. 2005;96:1339.PubMedCrossRefGoogle Scholar
  48. 48.
    Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44:637.PubMedCrossRefGoogle Scholar
  49. 49.
    Rosen RC, Giuliano F, Carson CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol. 2005;47:824.PubMedCrossRefGoogle Scholar
  50. 50.
    Vallancien G, Emberton M, Harving N, et al. Sexual dysfunction in 1,274 European men suffering from lower urinary tract symptoms. J Urol. 2003;169:2257.PubMedCrossRefGoogle Scholar
  51. 51.
    McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int. 2006;97 Suppl 2:23.PubMedCrossRefGoogle Scholar
  52. 52.
    McVary KT, Rademaker A, Lloyd GL, et al. Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2005;174:1327.PubMedCrossRefGoogle Scholar
  53. 53.
    Sairam K, Kulinskaya E, McNicholas TA, et al. Sildenafil influences lower urinary tract symptoms. BJU Int. 2002;90:836.PubMedCrossRefGoogle Scholar
  54. 54.
    Mulhall JP, Guhring P, Parker M, et al. Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. J Sex Med. 2006;3:662.PubMedCrossRefGoogle Scholar
  55. 55.
    Porst H, McVary KT, Montorsi F, et al. Effects of once-daily tadalafil on erectile function in men with erectile dysfunction and signs and symptoms of benign prostatic hyperplasia. Eur Urol. 2009;56:727.PubMedCrossRefGoogle Scholar
  56. 56.
    McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387.PubMedCrossRefGoogle Scholar
  57. 57.
    Becher E, Roehrborn CG, Siami P, et al. The effects of dutasteride, tamsulosin, and the combination on storage and voiding in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the Combination of Avodart and Tamsulosin study. Prostate Cancer Prostatic Dis. 2009;12:369.PubMedCrossRefGoogle Scholar
  58. 58.
    Barkin J, Roehrborn CG, Siami P, et al. Effect of dutasteride, tamsulosin and the combination on patient-reported quality of life and treatment satisfaction in men with moderate-to-severe benign prostatic hyperplasia: 2-year data from the CombAT trial. BJU Int. 2009;103:919.PubMedCrossRefGoogle Scholar
  59. 59.
    Roehrborn CG, Siami P, Barkin J, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57:123.PubMedCrossRefGoogle Scholar
  60. 60.
    Jeong YB, Kwon KS, Kim SD, et al. Effect of discontinuation of 5alpha-reductase inhibitors on prostate volume and symptoms in men with BPH: a prospective study. Urology. 2009;73:802.PubMedCrossRefGoogle Scholar
  61. 61.
    Kaplan SA, Walmsley K, Te AE. Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol. 2005;174:2273.PubMedCrossRefGoogle Scholar
  62. 62.
    Athanasopoulos A, Gyftopoulos K, Giannitsas K, et al. Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol. 2003;169:2253.PubMedCrossRefGoogle Scholar
  63. 63.
    Blake-James BT, Rashidian A, Ikeda Y, et al. The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. BJU Int. 2007;99:85.PubMedCrossRefGoogle Scholar
  64. 64.
    Kaplan S, Gonzalez R, Te A. Combination of alfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Eur Urol. 2007;51:1717.PubMedCrossRefGoogle Scholar
  65. 65.
    Roehrborn CG, McVary KT, Elion-Mboussa A, et al. Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol. 2008;180:1228.PubMedCrossRefGoogle Scholar
  66. 66.
    Stief CG, Porst H, Neuser D, et al. A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol. 2008;53:1236.PubMedCrossRefGoogle Scholar
  67. 67.
    Dmochowski R, Roehrborn C, Klise S, et al. Urodynamic effects of once daily tadalafil in men with lower urinary tract symptoms secondary to clinical benign prostatic hyperplasia: a randomized, placebo controlled 12-week clinical trial. J Urol. 2010;183:1092.PubMedCrossRefGoogle Scholar
  68. 68.
    Tuncel A, Nalcacioglu V, Ener K, et al. Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. World J Urol. 2010;28:17.PubMedCrossRefGoogle Scholar
  69. 69.
    Chung DE, Te AE, Staskin DR, et al. Efficacy and safety of tolterodine extended release and dutasteride in male overactive bladder patients with prostates >30 grams. Urology. 2010;75:1144.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Bilal Chughtai
    • 1
  • Richard Lee
    • 2
  • Matthew Hall
    • 3
  • Alexis E. Te
    • 4
    Email author
  1. 1.Department of UrologyWeill Cornell Medical CenterNew YorkUSA
  2. 2.Department of UrologyWeill-Cornell Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of UrologyMount Sinai School of MedicineNew YorkUSA
  4. 4.Department of UrologyWeill Cornell Medical Center, Brady Prostate Center and Urodynamic Laboratory, New York Presbyterian-CornellNew YorkUSA

Personalised recommendations