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Place of overactive bladder in male lower urinary tract symptoms

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Abstract

Lower urinary tract symptoms (LUTS) are highly prevalent in older men and women. Overactive bladder symptom syndrome (OAB) comprises the storage subset of LUTS and, in both sexes, is the most bothersome. The management of male LUTS has however, been disproportionately dominated in the past by an emphasis on prostatic pathology (bladder outlet obstruction (BOO) and prostatic enlargement). Pharmacotherapy that targets the prostate (e.g., α1-adrenoceptor antagonists) often fails to alleviate OAB symptoms, while many studies suggest that antimuscarinic therapy alone, or in combination with α1-adrenoceptor antagonists, can improve OAB symptoms in men with and without BOO. Recent studies suggest that arterial obstructive disease, such as atherosclerosis, may cause OAB in both men and women via ischemia, hypoxia and oxidative stress in the bladder. In this context, the use of phosphodiesterase inhibitors has been suggested to be a potential pharmacotherapy for men with LUTS. This article provides a review of the place of OAB in male LUTS and its treatment and provides an opportunity to draw data from a number of sources into one manuscript for critical review.

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References

  1. Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 21:167–178

    Article  PubMed  Google Scholar 

  2. Irwin DE, Milsom I, Hunskaar S et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: Results of the EPIC study. Eur Urol 50:1306–1314 (discussion 1314–1315)

    Article  PubMed  Google Scholar 

  3. Chapple CR, Wein AJ, Abrams P et al (2008) Lower urinary tract symptoms revisited: a broader clinical perspective. Eur Urol 54(3):543–562

    Article  CAS  PubMed  Google Scholar 

  4. Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49(4):651–659

    Article  PubMed  Google Scholar 

  5. Homma Y, Yamaguchi O, Hayashi K (2005) An epidemiological survey of overactive bladder symptoms in Japan. BJU Int 96:1314–1318

    Article  PubMed  Google Scholar 

  6. Jepsen J, Bruskewitz R (2000) Clinical manifestations and treatment. In: Lepor H (ed) Prostatic diseases. WB Saunders Co., Philadelphia, pp 127–142

    Google Scholar 

  7. Donovan JL, Abrams P, Peters TJ et al (1996) The ICS-‘BPH’ study. The psychometric validity and reliability of the ICS male questionnaire. Br J Urol 77:554–562

    CAS  PubMed  Google Scholar 

  8. Peters TJ, Donovan JL, Kay HE et al (1997) The International Continence Society “Benign prostatic hyperplasia” Study: the botherosomeness of urinary symptoms. J Urol 157:885–889

    Article  CAS  PubMed  Google Scholar 

  9. Knutson T, Edlund C, Fall M et al (2001) BPH with coexisting overactive bladder dysfunction—an everyday urological dilemma. Neurourol Urodyn 20:237–247

    Article  CAS  PubMed  Google Scholar 

  10. Fusco F, Groutz A, Blaivas JG et al (2001) Videourodynamic studies in men with lower urinary tract symptoms: a comparison of community based versus referral urological practices. J Urol 166:910–913

    Article  CAS  PubMed  Google Scholar 

  11. Lee JY, Kim HW, Lee SJ et al (2004) Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder. BJU Int 94:817–820

    Article  CAS  PubMed  Google Scholar 

  12. Hyman MJ, Groutz A, Blaivas JG (2001) Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol 166:550–552 (discussion 553)

    Article  CAS  PubMed  Google Scholar 

  13. Abrams PH, Farrar DJ, Turner-Warwick RT et al (1979) The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol 121:640–642

    CAS  PubMed  Google Scholar 

  14. Ameda K, Koyanagi T, Nantani M et al (1994) The relevance of preoperative cystometrography in patients with benign prostatic hyperplasia: correlating the findings with clinical features and outcome after prostatectomy. J Urol 152:443–447

    CAS  PubMed  Google Scholar 

  15. Andersson JT (1976) Detrusor hyperreflexia in benign infravesical obstruction. J Urol 115:32

    Google Scholar 

  16. Abrams P (1985) The pathophysiology of male bladder outflow obstruction. In: Whitfield HN, Hendry WF (eds) Genito-urinary surgery. Churchill Livingstone, Edinburgh, pp 3760–3784

    Google Scholar 

  17. Thomas AW, Cannon A, Bartlett E et al (2004) The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int 93(6):745–750

    Article  CAS  PubMed  Google Scholar 

  18. Gosling JA, Gilpin SA, Dixon JS et al (1986) Decrease in the autonomic innervation of human detrusor muscle in outflow obstruction. J Urol 136:501–504

    CAS  PubMed  Google Scholar 

  19. Harrison SC, Hunnam GR, Farman P et al (1987) Bladder instability and denervation in patients with bladder outflow obstruction. Br J Urol 60:519–522

    Article  CAS  PubMed  Google Scholar 

  20. Speakman MJ, Brading AF, Gilpin CJ et al (1987) Bladder outflow obstruction—a cause of denervation supersensitivity. J Urol 138:1461–1466

    CAS  PubMed  Google Scholar 

  21. Sibley GN (1987) The physiological response of the detrusor muscle to experimental bladder outflow obstruction in the pig. Br J Urol 60:332–336

    Article  CAS  PubMed  Google Scholar 

  22. Harrison SC, Ferguson DR, Doyle PT (1990) Effect of bladder outflow obstruction on the innervation of the rabbit urinary bladder. Br J Urol 66:372–379

    Article  CAS  PubMed  Google Scholar 

  23. Greenland JE, Brading AF (2001) The effect of bladder outflow obstruction on detrusor blood flow changes during the voiding cycle in conscious pigs. J Urol 165:245–248

    Article  CAS  PubMed  Google Scholar 

  24. Seki N, Karim OM, Mostwin JL (1992) The effect of experimental urethral obstruction and its reversal on changes in passive electrical properties of detrusor muscle. J Urol 148:1957–1961

    CAS  PubMed  Google Scholar 

  25. Steers WD, Ciambotti J, Etzel B et al (1991) Alterations in afferent pathways from the urinary bladder of the rat in response to partial urethral obstruction. J Comp Neurol 310:401–410

    Article  CAS  PubMed  Google Scholar 

  26. Steers WD, De Groat WC (1988) Effect of bladder outlet obstruction on micturition reflex pathways in the rat. J Urol 140:864–871

    CAS  PubMed  Google Scholar 

  27. Chalfin SA, Bradley WE (1982) The etiology of detrusor hyperreflexia in patients with infravesical obstruction. J Urol 127:938–942

    CAS  PubMed  Google Scholar 

  28. Yokoyama O, Nagano K, Kawaguchi K et al (1994) The influence of prostatic urethral anesthesia in overactive detrusor in patients with benign prostatic hyperplasia. J Urol 151:1554–1556

    CAS  PubMed  Google Scholar 

  29. Lepor H, Machi G (1993) Comparison of AUA symptom index in unselected males and females between fifty-five and seventy-nine years of age. Urology 42:36–40 (discussion 40–41)

    Article  CAS  PubMed  Google Scholar 

  30. Chancellor MB, Rivas DA (1993) American urological association symptom index for women with voiding symptoms: lack of index specificity for benign prostate hyperplasia. J Urol 150:1706–1708 (discussion 1708–1709)

    CAS  PubMed  Google Scholar 

  31. Schatzl G, Temml C, Waldmuller J et al (2001) A comparative cross-sectional study of lower urinary tract symptoms in both sexes. Eur Urol 40:213–219

    Article  CAS  PubMed  Google Scholar 

  32. Mariappan P, Chong WL (2006) Prevalence and correlations of lower urinary tract symptoms, erectile dysfunction and incontinence in men from a multiethnic Asian population: results of a regional population-based survey and comparison with industrialized nations. BJU Int 98:1264–1268

    Article  PubMed  Google Scholar 

  33. Kaplan SA (2006) Male pelvic health: a urological call to arms. J Urol 176:2351–2352

    Article  PubMed  Google Scholar 

  34. Ponholzer A, Temml C, Wehrberger C et al (2006) The association between vascular risk factors and lower urinary tract symptoms in both sexes. Eur Urol 50:581–586

    Article  PubMed  Google Scholar 

  35. Azadzoi KM, Tarcan T, Kozlowski R et al (1999) Overactivity and structural changes in the chronically ischemic bladder. J Urol 162:1768–1778

    Article  CAS  PubMed  Google Scholar 

  36. Azadzoi KM, Shinde VM, Tarcan T et al (2003) Increased leukotriene and prostaglandin release, and overactivity in the chronically ischemic bladder. J Urol 169:1885–1891

    Article  CAS  PubMed  Google Scholar 

  37. Azadzoi KM, Heim VK, Tarcan T et al (2004) Alteration of urothelial-mediated tone in the ischemic bladder: role of eicosanoids. Neurourol Urodyn 23:258–264

    Article  CAS  PubMed  Google Scholar 

  38. Azadzoi KM (2003) Effect of chronic ischemia on bladder structure and function. Adv Exp Med Biol 539:271–280

    PubMed  Google Scholar 

  39. Shenfeld OZ, Meir KS, Yutkin V et al (2005) Do atherosclerosis and chronic bladder ischemia really play a role in detrusor dysfunction of old age? Urology 65:181–184

    Article  PubMed  Google Scholar 

  40. Gill HS, Monson FC, Wein AJ et al (1988) The effects of short-term in-vivo ischemia on the contractile function of the rabbit urinary bladder. J Urol 139:1350–1354

    CAS  PubMed  Google Scholar 

  41. Masuda H, Kihara K, Saito K et al (2008) Reactive oxygen species mediate detrusor overactivity via sensitization of afferent pathway in the bladder of anaesthetized rats. BJU Int 101:775–780

    Article  CAS  PubMed  Google Scholar 

  42. Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–658

    Article  PubMed  Google Scholar 

  43. Tiwari A, Krishna NS, Nanda K et al (2005) Benign prostatic hyperplasia: an insight into current investigational medical therapies. Expert Opin Investig Drugs 14:1359–1372

    Article  CAS  PubMed  Google Scholar 

  44. Schwinn DA, Roehrborn CG (2008) α1-Adrenoceptor subtypes and lower urinary. tract symptoms 15(3):193–199

    CAS  Google Scholar 

  45. Narayan P, Tewari A (1998) 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 160:1701–1706

    Article  CAS  PubMed  Google Scholar 

  46. Lepor H (1998) Phase iii multicenter placebo-controlled study of tamsulosin in benign prostatic hyperplasia. Tamsulosin investigator group. Urology 51:892–900

    Article  CAS  PubMed  Google Scholar 

  47. Abrams P, Schulman CC, Vaage S (1995) Tamsulosin, a selective alpha 1c-adrenoceptor antagonist: a randomized, controlled trial in patients with benign prostatic ‘obstruction’ (symptomatic BPH). The European tamsulosin study group. Br J Urol 76:325–336

    Article  CAS  PubMed  Google Scholar 

  48. Kawabe K, Yoshida M, Homma Y (2006) 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 98:1019–1024

    Article  CAS  PubMed  Google Scholar 

  49. Reynard JM (2004) Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents? Curr Opin Urol 14:13–16

    Article  PubMed  Google Scholar 

  50. Andersson KE (2004) Antimuscarinics for treatment of overactive bladder. Lancet Neurol 3:46–53

    Article  CAS  PubMed  Google Scholar 

  51. Abrams P, Kaplan S, De Koning Gans HJ et al (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175:999–1004 (discussion 1004)

    Article  CAS  PubMed  Google Scholar 

  52. Roehrborn CG, Abrams P, Rovner ES et al (2006) Efficacy and tolerability of tolterodine extended-release in men with overactive bladder and urgency urinary incontinence. BJU Int 97:1003–1006

    Article  CAS  PubMed  Google Scholar 

  53. Athanasopoulos A, Gyftopoulos K, Giannitsas K et al (2003) Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 169:2253–2256

    Article  CAS  PubMed  Google Scholar 

  54. Kaplan SA, Roehrborn CG, Rovner ES et al (2006) Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 296:2319–2328

    Article  CAS  PubMed  Google Scholar 

  55. Chapple C, Herschorn S, Abrams P et al (2009) Tolterodine treatment improves storage symptoms suggestive of overactive bladder in men treated with α blockers. Eur Urol 56:534–543

    Google Scholar 

  56. MacDiarmid SA, Peters KM, Chen A et al (2008) Efficacy and safety of extended-release oxybutinin in combination with tamsulosin for treatment of lower urinary tract symptoms in men; Randomized, double-blind, placebo-controlled study. Mayo Clin Proc 83(9):1002–1010

    Article  CAS  PubMed  Google Scholar 

  57. Rosen R, Altwein J, Boyle P et al (2003) Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (msam-7). Eur Urol 44:637–649

    Article  PubMed  Google Scholar 

  58. Ponholzer A, Temml C, Obermayr R et al (2004) Association between lower urinary tract symptoms and erectile dysfunction. Urology 64:772–776

    Article  PubMed  Google Scholar 

  59. McVary KT (2005) Erectile dysfunction and lower urinary tract symptoms secondary to BPH. Eur Urol 47:838–845

    Article  PubMed  Google Scholar 

  60. El-Sakka AI (2005) Lower urinary tract symptoms in patients with erectile dysfunction: is there a vascular association? Eur Urol 48:319–325

    Article  PubMed  Google Scholar 

  61. Rosen RC, Giuliano F, Carson CC (2005) Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 47:824–837

    Article  PubMed  Google Scholar 

  62. Hoesl CE, Woll EM, Burkart M et al (2005) Erectile dysfunction (ED) is prevalent, bothersome and underdiagnosed in patients consulting urologists for benign prostatic syndrome (BPS). Eur Urol 47:511–517

    Article  CAS  PubMed  Google Scholar 

  63. Truss MC, Stief CG, Uckert S et al (2001) Phosphodiesterase 1 inhibition in the treatment of lower urinary tract dysfunction: from bench to bedside. World J Urol 19:344–350

    Article  CAS  PubMed  Google Scholar 

  64. Uckert S, Kuthe A, Jonas U et al (2001) Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. J Urol 166:2484–2490

    Article  CAS  PubMed  Google Scholar 

  65. Gillespie JI, Markerink-van Ittersum M, De Vente J (2006) Endogenous nitric oxide/cgmp signalling in the guinea pig bladder: evidence for distinct populations of sub-urothelial interstitial cells. Cell Tissue Res 325:325–332

    Article  CAS  PubMed  Google Scholar 

  66. McVary KT, Monnig W, Camps JL Jr et al (2007) Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 177:1071–1077

    Article  CAS  PubMed  Google Scholar 

  67. Roehrborn CG (2006) Advances in the treatment of lower urinary tract symptoms and benign prostatic hyperplasia: highlights from the 21st European Association of Urology congress, April 5–8, 2006, Paris, France. Rev Urol 8:216–225

    PubMed  Google Scholar 

  68. Kaplan SA, Gonzalez RR, Te AE (2007) Combination of alfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Eur Urol 51:1717–1723

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest statement

O. Yamaguchi has received no support from industry in the last 12 months, however part of the content of this manuscript contains some of the proceedings of a meeting which was supported by an unrestricted educational grant from Astellas in the previous year.

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  1. Department of Urology, Fukushima Medical University, Fukushima, 960-1295, Japan

    Osamu Yamaguchi, Ken Aikawa, Keiichi Shishido & Masanori Nomiya

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  1. Osamu Yamaguchi
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Correspondence to Osamu Yamaguchi.

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Yamaguchi, O., Aikawa, K., Shishido, K. et al. Place of overactive bladder in male lower urinary tract symptoms. World J Urol 27, 723–728 (2009). https://doi.org/10.1007/s00345-009-0470-5

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