Pharmacological treatment of lower urinary tract symptoms in men: Implementation of recommendations in clinical practice

Abstract

ContextIntroducing a consensus on pharmacological treatment of male LUTs to be applied to Urology Primary Care. Evidence compilationThe consensus has been created by an expert committee based on the latest recommendations by the European and American Guides for male LUTs treatment. Also, a bibliographic review of the latest advances in the therapeutical approach to these patients has been carried out. Evidence synthesisAlthough the prevalence of both LUTs and overactive bladder is high, and its impact on the quality of life and social cost has been widely described, the number of patients treated is low. On the other hand, current clinical practice does not necessarily match the Guides and for this reason false perceptions of the available treatments circulate. For instance, men with storage LUTS are often treated inadequately with α-blockers or 5-α-reductase inhibitors due to underlying obstructive disorders. However, it is known that the incidence of real obstruction tends to be low. Current evidence, though limited, shows that antimuscarinic drugs may be used safely by men with LUTs, and are not associated with an increase in the prevalence of high urinary retention. ConclusionWe propose an algorithm for the management of male LUTs in which various levels of clinical evaluation are shown for a specific diagnose, as well as for choosing the most appropriate treatment.