An algorithm for medical management in male lower urinary tract symptoms

Benign prostatic hyperplasia (BPH) as the main cause of lower urinary tract symptoms (LUTS) may lead to acute urinary retention and need for BPH-related surgery. The present article describes the result of the recent trials on different medical treatment options.

Recent studies have shown the efficacy of new selective α-blockers (silodosin and naftopidil); however, there are limited data and no strong evidence for the use of these new agents. Combination therapy of α-blocker and 5α-reductase inhibitor results in great benefit for symptom improvement as well as risk reduction of disease progression and complications. The use of selective antimuscarinic agents in patients with moderate-to-severe symptoms and nonobstructive pattern recognized as overactive bladder type has also been successfully evaluated. There is also a potential clinical use of phosphodiesterase type 5 inhibitors in patients with coexisting LUTS and erectile dysfunction.

Initial evaluation and filling appropriate questionnaires of the disease severity and quality are important steps in medical management of LUTS. Other comorbidities including erectile dysfunction, cardiovascular diseases should also be evaluated. Using prostate volume, uroflowmetry, serum PSA, one could estimate the risk of clinical progression. Most patients benefit from combination therapy of α-blocker and 5α-reductase inhibitor.