Refractory overactive bladder in men: update on novel therapies

Area of Science:

• Urology
• Men's Health
• Pharmacology

Background:

• Overactive bladder (OAB) in men presents diagnostic and therapeutic challenges, particularly when co-occurring with bladder outlet obstruction.
• Traditional treatments for lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) include alpha-blockers and 5-alpha-reductase inhibitors, followed by surgery.
• Persistent LUTS secondary to OAB can occur even after successful surgical interventions for BPH.

Purpose of the Study:

• To review the diagnostic and treatment strategies for overactive bladder in men.
• To discuss the role of antimuscarinic drugs in men with OAB, including those with concomitant bladder outlet obstruction.
• To explore advanced treatment options for refractory OAB in men.

Main Methods:

• Literature review of diagnostic approaches and therapeutic interventions for OAB in men.
• Analysis of the efficacy and safety of oral antimuscarinic drugs.
• Evaluation of surgical outcomes and subsequent OAB management.
• Review of neuromodulation and botulinum toxin as treatment modalities.

Main Results:

• Antimuscarinic drugs are indicated for men with persistent OAB symptoms, even with unre lieved bladder outlet obstruction, with careful risk assessment for urinary retention.
• For cases refractory to oral medications, neuromodulation and intradetrusor injections of botulinum toxin are effective options.
• A stepwise approach combining conservative measures, pharmacotherapy, and advanced interventions is crucial.

Conclusions:

• Men with OAB, especially those with bladder outlet obstruction, benefit from a structured treatment algorithm.
• Antimuscarinic therapy is a viable option, with careful consideration of potential side effects.
• Refractory OAB in men can be effectively managed with neuromodulation and botulinum toxin injections.