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Evaluation and Treatment of Male Lower Urinary Tract Symptoms

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Part of the book series: Current Clinical Urology ((CCU))

Abstract

Male lower urinary tract symptoms (LUTS) comprise one of the most common medical conditions in aging men. The most common cause of these voiding symptoms is due to prostatic obstruction secondary to benign prostatic hypertrophy (BPH). LUTS management consumes a growing portion of medical expenditures and is expected to more than double in the next 25 years. In the present day, this problem is likely to be initially treated by a primary care physician with only cases refractory to initial therapy referred to the urologist for consideration of further treatment. Given that over 12.5 million visits per year are related to BPH/LUTS-related management, it is imperative that the primary care physician have knowledge of the etiology, differential diagnosis, evaluation, and treatment of this common complaint. This chapter serves to review the most up-to-date management guidelines as recommended by the American Urologic Association (AUA), focusing on the essentials for the primary care physician.

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References

  1. Parsons JK. Benign prostatic hyperplasia and male lower urinary tract symptoms: epidemiology and risk factors. Curr Bladder Dysfunct Rep. 2010;5(4):212–8.

    Article  PubMed  Google Scholar 

  2. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173(4):1256–61.

    Article  PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention (CDC). Trends in aging—United States and worldwide. Morb Mortal Wkly Rep. 2003;52(6):101–4, 106.

    Google Scholar 

  4. Stroup SP, Palazzi-Churas K, Kopp RP, Parsons JK. Trends in adverse events of benign prostatic hyperplasia (BPH) in the USA, 1998 to 2008. BJU Int. 2012;109(1):84–7.

    Article  PubMed  Google Scholar 

  5. Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am. 2011;95(1):87–100.

    Article  PubMed  Google Scholar 

  6. Weiss JP, Blaivas JG, Bliwise DL, et al. The evaluation and treatment of nocturia: a consensus statement. BJU Int. 2011;108(1):6–21.

    Article  PubMed  Google Scholar 

  7. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int. 2005;96(9):1301–6.

    Article  PubMed  Google Scholar 

  8. Housami F, Abrams P. Persistent detrusor overactivity after transurethral resection of the prostate. Curr Urol Rep. 2008;9(4):284–90.

    Article  PubMed  Google Scholar 

  9. Levin RM, Monson FC, Haugaard N, et al. Genetic and cellular characteristics of bladder outlet obstruction. Urol Clin North Am. 1995;22(2):263–83.

    PubMed  CAS  Google Scholar 

  10. Vallancien G, Emberton M, Alcaraz A, et al. Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice. BJU Int. 2008;101(7):847–52.

    Article  PubMed  CAS  Google Scholar 

  11. Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17–21.

    Article  PubMed  Google Scholar 

  12. McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803.

    Article  PubMed  Google Scholar 

  13. Kolman C, Girman CJ, Jacobsen SJ, Lieber MM. Distribution of post-void residual urine volume in randomly selected men. J Urol. 1999;161(1):122–7.

    Article  PubMed  CAS  Google Scholar 

  14. Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol. 2008;180(1):47–54.

    Article  PubMed  Google Scholar 

  15. Abrams P. In support of pressure-flow studies for evaluating men with lower urinary tract symptoms. Urology. 1994;44(2):153–5.

    Article  PubMed  CAS  Google Scholar 

  16. McConnell JD. Why pressure-flow studies should be optional and not mandatory studies for evaluating men with benign prostatic hyperplasia. Urology. 1994;44(2):156–8.

    Article  PubMed  CAS  Google Scholar 

  17. Wei JT, Miner MM, Steers WD, et al. Benign prostatic hyperplasia evaluation and management by urologists and primary care physicians: practice patterns from the observational BPH registry. J Urol. 2011;186(3):971–6.

    Article  PubMed  Google Scholar 

  18. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Eng J Med. 2006;354(6):557–66.

    Article  CAS  Google Scholar 

  19. Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306(12):1344–51.

    Article  PubMed  CAS  Google Scholar 

  20. 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 Eng J Med. 2003;349(25):2387–98.

    Article  CAS  Google Scholar 

  21. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. JAMA. 2000;283(15):1967–75

    Google Scholar 

  22. 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(1):123–31.

    Article  PubMed  Google Scholar 

  23. Roehrborn CG, Bruskewitz R, Nickel GC, et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. The PLESS Study Group. Eur Urol. 2000;37(5):528–36.

    Article  PubMed  CAS  Google Scholar 

  24. Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. N Eng J Med. 2003;349(3):215–24.

    Article  CAS  Google Scholar 

  25. Andriole GL, Bostwick DG, Brawley OW, et al. Effect of dutasteride on the risk of prostate cancer. N Eng J Med. 2010;362(13):1192–202.

    Article  CAS  Google Scholar 

  26. Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol. 2006;175(3):999–1004.

    Article  PubMed  CAS  Google Scholar 

  27. Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006;296(19):2319–28.

    Article  PubMed  CAS  Google Scholar 

  28. Martin-Merino E, Garcia-Rodriguez LA, Masso-Gonzalez EL, Roehrborn CG. Do oral antimuscarinic drugs carry an increased risk of acute urinary retention? J Urol. 2009;182(4):1442–8.

    Article  PubMed  Google Scholar 

  29. Sears CL, Lewis C, Noel K, Albright TS, Fischer JR. Overactive bladder medication adherence when medication is free to patients. J Urol. 2010;183(3):1077–81.

    Article  PubMed  Google Scholar 

  30. Nichol MB, Knight TK, Wu J, Barron R, Penson DF. Evaluating use patterns of and adherence to medications for benign prostatic hyperplasia. J Urol. 2009;181(5):2214–21 [discussion 2221–2].

    Article  PubMed  Google Scholar 

  31. Hoffman RM, Monga M, Elliot SP, Macdonald R, Wilt TJ. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2007;4:CD004135.

    PubMed  Google Scholar 

  32. Wagrell L, Schelin S, Nordling J, et al. Feedback microwave thermotherapy versus TURP for clinical BPH—a randomized controlled multicenter study. Urology. 2002;60(2):292–9.

    Article  PubMed  Google Scholar 

  33. Roehrborn CG, Issa MM, Bruskewitz RC, et al. Transurethral needle ablation for benign prostatic hyperplasia: 12-month results of a prospective, multicenter U.S. study. Urology. 1998;51(3):415–21.

    Article  PubMed  CAS  Google Scholar 

  34. Capitan C, Blazquez C, Martin MD, Hernandez V, de la Pena E, Llorente C. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol. 2011;60(4):734–9.

    Article  PubMed  Google Scholar 

  35. Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003;170(4 Pt 1):1270–4.

    Article  PubMed  CAS  Google Scholar 

Selected Readings

  • Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Eng J Med. 2006;354(6):557–66.

    Article  CAS  Google Scholar 

  • Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int. 2011;107(7):1030–43.

    Article  PubMed  Google Scholar 

  • Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol. 2008;180(1):47–54.

    Article  PubMed  Google Scholar 

  • McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803.

    Article  PubMed  Google Scholar 

  • Nichol MB, Knight TK, Wu J, Barron R, Penson DF. Evaluating use patterns of and adherence to medications for benign prostatic hyperplasia. J Urol. 2009;181(5):2214–21 [discussion 2221–2].

    Article  PubMed  Google Scholar 

  • Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17–21.

    Article  PubMed  Google Scholar 

  • Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173(4):1256–61.

    Article  PubMed  Google Scholar 

  • Weiss JP, Blaivas JG, Bliwise DL, et al. The evaluation and treatment of nocturia: a consensus statement. BJU Int. 2011;108(1):6–21.

    Article  PubMed  Google Scholar 

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Correspondence to Christopher S. Elliott .

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Elliott, C.S., Payne, C.K. (2012). Evaluation and Treatment of Male Lower Urinary Tract Symptoms. In: Potts, J. (eds) Essential Urology. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-092-2_14

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  • DOI: https://doi.org/10.1007/978-1-62703-092-2_14

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-091-5

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