Videourodynamics for Male Lower Urinary Tract Symptoms: Indications and Interpretation

Lower urinary tract symptoms (LUTS) are prevalent and bothersome symptoms, both for males and females.1 Most attention is given to LUTS in older males because in this group the prevalence is high and doctor visits are more common.2 The possibilities for physicians — both GPs as well as urologists — to encounter LUTS in daily practice are limited. The 2010 guideline The Management of Lower Urinary Tract Symptoms in Men , by the National Institute for Health and Clinical Excellence (NICE), presents an authority-based algorithm for this patient group. Education about the natural history of LUTS and the reassurance that LUTS are not caused by prostate cancer are important specific anchors for GPs and their patients.3,4 Treatment options for GPs are restricted to physiotherapy, alpha-blocking agents, 5-alpha reductase inhibitors, anticholinergics, or combination therapy.3 Urologists may offer operative treatment in those with severe symptoms not responding to non-invasive treatment. The efficacy and effectiveness of treatments for LUTS in older males are limited.3 The probable explanation is that LUTS are multifactorial in their origin, whereas the therapeutic approach is simplistic, targeting specific organs. Prostatic pathophysiology — especially prostate enlargement and prostate obstruction — was long thought to be the explanation for (nearly all) LUTS in older males and most of the drugs approved for LUTS in males aim to influence prostate function. Evidence is growing that this is a misconception. It is now clear that prostate enlargement or benign prostate obstruction is not the common cause of male LUTS.5 Many men with LUTS do not have prostate enlargement nor prostatic obstruction, whereas many men with an enlarged …

ABSTRACTIn this review, we focus on current trends in the management of male lower urinary tract symptoms (LUTS), defined here as LUTS, namely, storage, voiding, and post-micturition symptoms presumed secondary to benign prostatic hyperplasia (BPH), and discuss possible novel approaches toward better care.According to results of a PubMed database search covering the last 10 years and using keywords pertaining to male LUTS, this condition continues to be globally undiagnosed or diagnosed late, partly because of men’s hesitation to seek help for perceived embarrassing problems or problems considered a normal part of aging. In addition, the prevalence of male LUTS is continually increasing because of a constantly aging population. Male LUTS can be bothersome and affect the quality of life (QoL) and sexual function. Additional effective alternatives for managing this condition need to be identified and incorporated into the current care model.Considering that most male LUTS such as frequency, hesitancy, urgency, and intermittency are easy to self-identify, a self-management approach toward male LUTS is proposed. Limited evidence supports the efficacy of phytotherapies and herbals as self-management options for male LUTS. However, introducing over-the-counter (OTC) medication with proven efficacy, accompanied by lifestyle and behavioral modifications, may be a promising approach that will encourage more men to treat their symptoms in a timely manner. Formal guidelines, along with appropriate education programs for patients and support from the healthcare community, will be needed to ensure that the promise of this approach is fully materialized.

Metabolomics Approach to Male Lower Urinary Tract Symptoms: Identification of Possible Biomarkers and Potential Targets for New Treatments

Historically, urologists regarded prostate enlargement as the sole cause for male bladder problems. Over time, subdivision of symptoms into storage, voiding and post-voiding symptoms raised awareness of the urinary tract fine-tuning associated with urine storage and voiding, and led to the umbrella term lower urinary tract symptoms (LUTS), which respects bladder and prostate function. While research goes on, it seems as if the more we know about urine storage and voiding, the more complicated it gets: different mechanism can mimic the same symptoms. Clinically, it remains ever the more challenging to understand the pathophysiological context of each patient. Metabolic syndrome (MetS), too, is an umbrella term. Metabolic changes caused by MetS pathophysiologically start with visceral adiposity. It leads to different changes in the signaling pathway including cytokines, elevated transmitters of inflammation, higher levels of free fatty acids (FFA), and adipokines, resulting in vasoconstriction, insulin resistance, impaired glucose uptake and high insulin secretion. Furthermore, MetS is thought to be associated with nephrolithiasis, BPH, LUTS, erectile dysfunction (ED), and infertility. This review aims at synthesizing interactions and consequences of LUTS with MetS. On May 31st, 2021, PubMed and Cochrane were searched with no language nor time restrictions, using the terms "Metabolic syndrome" and "male LUTS." A total of 252 publications were identified. Only papers that mentioned both terms either in their title or in their abstract were included. Hence, 120 papers were reviewed. Many different findings cause LUTS, which are summarized in the EAU Guidelines on male non-neurogenic LUTS. These different symptoms belong to different phases of bladder function. Frequency, nocturia, urgency and incontinence are symptoms of the filling phase, while hesitancy, intermittency, weak or irregular stream, straining and terminal dribble belong to the voiding phase of the bladder. Post-voiding symptoms include post-void dribbling and sensation of incomplete voiding. Symptoms of any phase of bladder function impair quality of life, and are associated with ageing. Inflammation links both umbrella terms, LUTS and MetS. Understanding the exact role of the different elements will not only help to better understand both findings, but also lead to more efficacious treatment, and hopefully, in the future, personalized medicine, by understanding each individual's driving mechanism for LUTS. Reducing inflammation is likely to help patients with MetS and LUTS; further research could therefore focus on how to manage inflammation.

EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction

Risk Factors for Male Lower Urinary Tract Symptoms: The Role of Metabolic Syndrome and Androgenetic Alopecia in a Latin American Population

According to prevailing clinical wisdom, most male lower urinary tract symptoms have been ascribed to disorders of the bladder outlet and the prostate gland in particular. Therefore, most pharmacologic therapy and surgical therapy has been directed toward the prostate. However, emerging laboratory and clinical data suggest that the bladder may be an important factor in the genesis of male lower urinary tract symptomatology, often independent of bladder outlet disorders. Overactive bladder, a diagnosis given to women with urinary frequency, urgency, and nocturia, clearly also occurs in men. In this context, and with the proliferation of various terminology changes describing lower urinary tract function, it is increasingly important to use precise and correct terminology when referring to male voiding symptoms and their treatment. Further, the traditional application of pharmacologic therapy for male lower urinary tract symptoms (LUTS) is undergoing changes, with antimuscarinics being used in some men with LUTS either alone or in combination with other oral therapies such as α-blockers. The therapy for LUTS in men will continue to evolve as newer agents in various pharmacologic classes become available.

Re: Burden of Male Lower Urinary Tract Symptoms (LUTS) Suggestive of Benign Prostatic Hyperplasia (BPH)—Focus on the UK

To translate and cross-culturally adapt the English version of the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms (ICIQ-MLUTS)into Brazilian Portuguese and evaluate its psychometric properties. Male lower urinary tract symptoms (LUTS)are frequent and commonly assessed with questionnaires. The ICIQ-MLUTSis a robust instrument that investigates the main aspects of LUTS in men and their impact on quality of life. Although highly recommended, Grade A is not as popular as the International Prostate Symptom Score (IPSS)and remained untranslated and unvalidated for Brazilian Portuguese. After authorization by the Advisory Board of the International Consultation on Incontinence (ICIQ) the translation process was conducted according to the standard guidelines and the ICIQ validation protocol. Internal consistency was assessed using Cronbach's ⍺ coefficient and values > 0.7 were considered satisfactory. To assess test-retest reliability and reproducibility, Spearman's correlation coefficient and intraclass correlation coefficient were used. For group data, a Spearman correlation coefficient or an intraclass correlation coefficient of at least 0.70 demonstrates good test-retest reliability. A p < 0.05 was considered significant. One hundred and eighty-six, aged61.41 ± 11.01 years, suffering from LUTS participated in the study between January 2021 and October 2022. Cronbach's ⍺, 0.875, demonstrated the internal consistency of the Portuguese version of ICIQ-MLUTS.The intraclass correlation coefficient of 0.912 (0.882; 0.935 - 95% CI)for the test-retest evidenced the stability and validity of the instrument. Likewise, Spearman's correlation coefficient highlighted the agreement between IPSS and ICIQ-MLUTS,0.906, <0.001. The Portuguese version of the ICIQ-MLUTSdemonstrated internal consistency, stability, and validity, in addition to agreement with the IPSS. The ICIQ-MLUTS,translated and validated into Brazilian Portuguese, is a robust and reliable instrument to assess LUTS in Brazilian men and can be used in the evaluation of treatment and research.

Lower urinary tract symptoms (LUTS) in men are due to bladder dysfunction or bladder outlet disorders such as benign prostatic enlargement and bladder neck or urethral sphincter dysfunction. Men with lower urinary tract symptoms prefer shared problem-solving and decision making during treatment planning. Urodynamic studies (UDS) in male LUTS (MLUTS) are useful for both diagnosis and prognosis. UDS help both the clinician and the patient in shared decision making regarding treatment of these men. The AUA/SUFU guidelines and EAU guidelines are helpful in cost-effective selection of patients with MLUTS for urodynamic evaluation. UDS are indicated in the subset of patients with MLUTS being considered for invasive and potentially morbid therapy. Uroflowmetry and post-void residual (PVR) volume measurement by bladder ultrasound scan are good screening tests in MLUTS. Urodynamic evidence of bladder outlet obstruction has been correlated with better outcomes following invasive therapy.

The Reduction of Male Lower Urinary Tract Symptoms Is Associated With a Decreased Risk of Death.

IntroductionIn March 2013, the European Association of Urology (EAU) released a new edition of the guidelines on management of male lower urinary tract symptoms (LUTS), including benign prostatic obstruction. The objective of this study was to evaluate how well the EAU guidelines have been implemented in day-to-day practice by Polish urologists.Material and methodsA structured questionnaire, which explored how urologists diagnose and manage male lower urinary tract symptoms, was emailed to all certified, actively practicing urologists from a list provided by the Polish Urological Association.ResultsThe questionnaire return rate was 33.7% (135/400). Overall, the median (quartile 1; quartile 3) frequency of correct answers was 65.0% (58.0%; 69.0%). Analysis of the association of availability and acceptance of the EAU guidelines with question answers showed no pattern. A multivariate regression model showed a positive correlation with regards to correct answers given in the survey and doctors’ participation in international congresses (p = 0.018, r = 0.181). Basket analysis showed the strongest association for those who failed to correctly answer the questions regarding diagnosis of LUTS and overactive bladder (OAB) (support = 27.41%, confidence = 86.05%).ConclusionsAlthough there is a significant degree of adherence to the 2013 EAU guidelines, some discrepancies between urologists’ practice and the recommendations regarding diagnosis and treatment of male LUTS do exist. The data obtained provide valuable benchmarks and also identify possible interventions that may improve the standard of care in this population of patients.

Hot Topics in the Clinical Practice Guidelines for Treatment of Male Lower Urinary Tract Symptoms due to Benign Prostatic Obstruction

Future Direction in Pharmacotherapy for Non-neurogenic Male Lower Urinary Tract Symptoms

LUTS (R)evolution: Let's Jump on the Bandwagon