The role of anticholinergic drugs in men with lower urinary tract symptoms

Male lower urinary tract symptoms are often attributed to benign prostatic hyperplasia. However, coexisting overactive bladder may be responsible for storage symptoms in a substantial proportion. Treatment of these symptoms with anticholinergic drugs has been considered hazardous in benign prostatic hyperplasia because of concerns that they may predispose to acute urinary retention. We present recent research evidence on the effectiveness and safety of anticholinergics for male lower urinary tract symptoms.

Two systematic reviews and a large randomized controlled trial recently evaluated anticholinergic drugs in men with lower urinary tract symptoms. These studies provided good evidence that anticholinergics are effective at improving both urodynamic and patient-reported outcomes. Postvoid residual urine volumes and urine flow rates were not significantly affected, and acute urinary retention was rare.

In men with lower urinary tract symptoms treatment may need to be directed at both the prostate and the bladder, and a pragmatic approach therefore seems appropriate. Men presenting with lower urinary tract symptoms should undergo comprehensive clinical evaluation before benign prostatic hyperplasia is treated, if indicated. Should symptoms fail to resolve, addition of anticholinergic drugs may be considered in the absence of significant postvoid residual urine volumes.