Lower urinary tract symptoms (LUTS) in men: thinking beyond the prostate.

VOLUME 93 NO. 2 FEBRUARY 2010 Lower Urinary Tract Symptoms (LUTS) in men are commonly thought to be related to benign enlargement of the prostate, BPE, a term that replaces the term, BPH (benign prostatic hyperplasia), which is a pathologic diagnosis. However, LUTS is not exclusive to men, nor is it only related to BPE. More recently, the role of underlying overactive bladder (OAB) has been highlighted in the etiology of male LUTS. LUTS is a symptom complex composed of storage and voiding phase symptoms. The storage phase symptoms consist of urinary urgency (a sudden compelling desire to void that is difficult to defer) with or without urinary urgency incontinence, urinary frequency (voiding 8 or more times per day), and nocturia (awakening one or more times at night to void) and the voiding phase symptoms include hesitancy, intermittent urinary stream, feeling of incomplete emptying, straining to void and post-void dribbling. The storage phase symptoms are those of OAB, a symptom complex, suggestive of underlying vesicourethral dysfunction. The National Overactive Bladder Evaluation (NOBLE) study, using a validated, computer-assisted telephone interview of 5204 adults in the United States > 18 yrs of age, identified the overall prevalence of OAB as 16.9% in women and 16.0% in men. The Males Attitudes Regarding Sexual Health Study demonstrated the overall prevalence of LUTS among US men > 40 yrs to be 13%, 9% and 6% for storage symptoms, mixed symptoms and voiding symptoms, respectively. 2 OAB symptoms in women are easily recognized and treated, but those in men, despite a similar prevalence, are not. In two large studies utilizing medical and pharmacy data from IMS Health, only 16-24% of men diagnosed with OAB were treated medically. 4 Simply treating the BPE and BOO symptoms of LUTS leaves a subset of male patients with inadequate control. Lee et al demonstrated that 65% of patients with BOO and overactive bladder treated with an alpha-blocker for 3 months did not show symptomatic improvement. Furthermore, 25 to 30% of males have persistent OAB symptoms after prostate surgery and OAB Lower Urinary Tract Symptoms (LUTS) In Men: Thinking Beyond the Prostate