Most recent findings of curative drugs for lower urinary tract symptoms in clinical practice

Abstract

As Japan enters into an aging society, aged patients with chief complaint of lower urinary tract symptoms (LUTS) have increased. The most common cause of LUTS in men older than 50 years is benign prostatic hyperplasia (BPH). In particular, LUTS associated with overactive bladder (OAB) symptoms was reported to have a significant negative impact on patient quality of life (QOL). In clinical practice, monotherapy with α1-blockers or PDE5 inhibitors is widely employed for the initial management of BPH accompanied by OAB (BPH/OAB). However, storage symptoms may persist in some patients. In patients with residual OAB symptoms despite α1-blocker or PDE5 inhibitor monotherapy, the addition of an anticholinergic agent or a β3-adrenergic receptor (β3-AR) agonist is recommended by the BPH guidelines. Although both agents have been shown to effectively improve OAB symptoms and bladder storage functions, it remains unclear which type of add-on therapy, anticholinergic agents or β3-AR agonists, is most effective for alleviating OAB symptoms and storage functions. Recently, detrusor underactivity (DU) is also considered to be a common cause of non-neurogenic LUTS in men. DU has been reported to be present in 9%-48% of men undergoing urodynamic evaluation for non-neurogenic LUTS. DU can lead to adverse health effects, in addition to significant burden and decreased QOL. Thus, development of a safe and effective treatment for patients with LUTS induced by DU is an urgent issue at present. In this paper, we will introduce most recent findings of curative drugs for LUTS, especially BPH/OAB and DU in clinical practice.