Medical management of lower urinary tract symptoms in men: current treatment and future approaches

Lower urinary tract symptoms (LUTS) are extremely common in men and, in addition to causing considerable bother, can lead to the development of complications, such as acute urinary retention. Over the past couple of decades, developments in the medical management of LUTS in men have led to a substantial decline in the number of surgical procedures being performed to treat associated disorders, such as prostatectomy for benign prostatic enlargement. In this Review we summarize the available treatments and discuss the latest data on the use of anticholinergics and phosphodiesterase type-5 inhibitors for this indication. We also review the various combinations of medical therapies that have been reported in the literature to optimize the management of LUTS in men. In addition, there is a growing realization that LUTS in men are not synonymous with prostatic disease, and in many patients overactive bladder syndrome is the cause or a component of the LUTS experienced; we have, therefore, taken the opportunity to try to clarify the terminology used in LUTS in men, since there is the potential for considerable confusion with the terms that are currently in common usage in any discussion of this disorder.