Phosphodiesterase Type 5 Inhibitors Improve Male Lower Urinary Tract Symptoms

Abstract

Low urinary tract symptoms (LUTS) encompass all urinary symptoms, including storage, voiding, and postmicturition symptoms. LUTS in men may be related to bladder outlet obstruction (BOO), which is often associated with benign prostatic hyperplasia (BPH). BPH incidence increases with age. It is present in about 50% of men over 50 yr, with prevalence increasing to up to 90% in those older than 80 yr. Altogether, 25% to 50% of men with histologically confirmed BPH have LUTS [1]. Male LUTS may also result from bladder dysfunction. Prostatic pathology and overactive bladder (OAB) symptoms are not always causally related, and many men with OAB symptoms do not have BOO. OAB symptoms may be more indicative of bladder dysfunction such as detrusor overactivity than prostatic conditions, and often persist after prostatectomy or transurethral resection of the prostate. The EPIC study [2], a population-based survey of urinary symptoms using the 2002 International Continence Society definition for LUTS, showed that OAB was present in 11% of men and that LUTS were highly prevalent, with a higher prevalence of storage (51.3%) versus voiding (25.7%) symptoms in men. Treatments that target the prostate, such as alpha 1-receptor antagonists and 5 alpha-reductase inhibitors, often fail to alleviate OAB symptoms and may not be the most appropriate therapy for men with storage LUTS.