Use of anticholinergic therapy in men

Lower urinary tract symptoms in men usually include symptoms of bladder overactivity such as urinary frequency, urgency or nocturia. These are often the initial presenting symptoms for men seeking medical attention for urinary dysfunction. The prevalence of overactive bladder in men is similar to women and increases with advancing age. While women with these symptoms are treated primarily with anticholinergic therapy, there is reluctance to use these agents in men due to concerns regarding worsening obstructive symptoms or urinary retention exacerbated by a large prostate. For men, alpha blocker monotherapy remains the primary therapy for lower urinary tract symptoms despite the fact that a larger fraction of men continue to experience symptoms of overactive bladder. There is emerging body of evidence that the use of anticholinergic agents may be safe and effective in men. We will discuss the rationale for the use of anticholinergic therapy in men with bladder overactivity, either alone, or in combination with alpha blockers. We will review the current literature on the topic and discuss potential future directions in the management of overactive bladder in men.