Roehrborn_EU_Genito.qxp 1/8/07 10:13 Page 64
Overactive Bladder
Male Lower Urinary Tract Symptoms –
Epidemiology, Terminology and Pathophysiology
a report by
Claus Roehrborn
Professor and Chairman, Department of Urology, University of Texas Southwestern Medical Center, Dallas
Lower urinary tract symptoms (LUTS) in men, related to conditions of the • the existence of alternative potential pathophysiology, such as bladder
bladder and/or the prostate, include a number of storage, voiding and dysfunction and/or prostate conditions;
7
and
post-micturition symptoms:
1
• concerns about the safety of the main treatment agents such as
antimuscarinic drugs, for example, concerning the clinical effect of a
• storage: urgency, frequency, nocturia, urgency incontinence and significant increase in post-void residue, and the presumed increase in
other incontinence; risk for acute urinary retention.
8
• voiding: hesitancy, poor flow, intermittency, straining and terminal
dribble; and Acute urinary retention (AUR) is defined as an inability to urinate that is
• post-micturition: post-void dribble and incomplete emptying. usually painful and requires catheterisation. It causes secondary to
increased resistance to the urinary flow, and weakness of detrusor muscle
Prevalence of LUTS in men is high. Roughly 61% of men in the general or interruption of sensory innervations of the bladder wall. In around half
population have at least one type of LUTS: around half of them have of cases AUR is spontaneous, although it may be precipitated by use of
storage problems; a quarter have voiding problems; and a sixth report anaesthesia, antihistamines or opioids.
9
Population-based longitudinal
post-micturition problems.
2
Most men with LUTS have both storage and studies estimate the incidence of AUR to be 0.2–0.7% per year in men
voiding/post-micturition symptoms; 67% of affected men experience over 40 years of age and, like LUTS, the prevalence increases with age.
symptoms of both overactive bladder (OAB) and benign prostatic
hyperplasia (BPH).
2
According to the expanded prostate cancer index
composite (EPIC) and the Swedish Institute for Opinion Surveys (SIFO)
Prevalence of lower urinary tract
studies, there is no difference between the overall prevalence of OAB –
symptoms (LUTS) in men is high.
one particular type of LUTS – in men and women, and both increase in
incidence with age starting at about age 40–45 years.
2,3
Roughly 61% of men in the general
population have at least one type
Health-related quality of life (HRQoL) is impaired in men with OAB. For
of LUTS…
concerns such as mobility, self-care, day-to-day activities, pain/discomfort
and anxiety/depression, men with OAB and incontinence have a much
lower reported HRQoL than continent men with OAB, and both have Defining and Treating Lower Urinary Tract Syndrome
lower HRQoLs than controls (as measured by the EuroQoL (EQ-5D) The International Continence Society (ICS) defines OAB as urgency, with
questionnaire).
4
However, although symptoms are bothersome, OAB or without urgency incontinence, usually with frequency and nocturia.
1
often remains underdiagnosed and undertreated. In a survey of patients OAB can be of neurogenic, myogenic, mixed or unknown origins.
10
BPH
who informed their physicians about OAB symptoms, only 27% were is defined by a typical histological pattern, but often has the physical
treated with medication.
5
There are several explanations for this difficulty effect of causing bladder outlet obstruction (BOO) owing to enlargement.
in diagnosis and prescribing appropriate medications: Men with OAB, which is typically caused by detrusor overactivity, may
have OAB as their primary condition, or they may have OAB as a
• complex clinical presentation of OAB symptoms in combination with secondary state to another condition such as BOO.
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other LUTS;
6
• complex terminology, including significant regional and country LUTS in general can be tackled in various ways. For BPH, typical
differences;
3
pharmacological treatment includes symptom control with α-1-
adrenergic receptor antagonists (α-blockers), while disease modification
can be achieved using 5-α-reductase inhibitors.
11
There are also surgical
Claus Roehrborn is Professor and Chairman of the options available. In OAB, antimuscarinics are the treatment of choice for
Department of Urology at the University of Texas
symptom control for storage-competent individuals. Lifestyle and
Southwestern Medical Center in Dallas. His research
interests concern medical therapy for benign prostatic
behavioural modifications can also be considered.
hypertrophy (BPH), minimally invasive therapy for BPH, role
of phytotherapies in BPH and urology, screening and early
Antimuscarinic Therapy
detection of prostate cancer, serum prostate-specific
antigen, treatment of prostate cancer, urological outcomes Antimuscarinic drugs are a class of anticholinergics that work by
research and epidemiology of urological disorders.
decreasing detrusor contractility. Several antimuscarinic drugs are
currently approved for use to to treat OAB (see Table 1).
64 © TOUCH BRIEFINGS 2007
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