Published online Jul 24, 2015. doi: 10.5410/wjcu.v4.i2.83
Peer-review started: August 6, 2014
First decision: September 28, 2014
Revised: April 23, 2015
Accepted: May 8, 2015
Article in press: May 11, 2015
Published online: July 24, 2015
Processing time: 363 Days and 14.3 Hours
The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms (LUTS). In this review, we summarise the conclusions from four of the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life (QoL) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and QoL available to men with LUTS. Meta-analyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.
Core tip: Men with lower urinary tract symptoms (LUTS) should be assessed not only for symptom severity and bother but also for risk of progression. Men with a PSA > 1.4 or a prostate larger than 30 mL should be considered for therapy to reduce prostate volume. With the options for management of men with LUTS also involving antimuscarinics, B3 agonists, phosphodiesterase inhibitors and a plethora or surgical options, a personalised approach is required. This is intended will lead to greatest patient satisfaction and improvement in quality of life.