Roehrborn_EU_Genito.qxp 1/8/07 10:14 Page 66
Overactive Bladder
antimuscarinic agent tolterodine in a population with BOO.
19
Using BOO or a mixture of the two. From there, medical or behavioural therapy,
urodynamic evaluation, 144 men were determined to have BOO with or surgical options, can be discussed. For mixed scenarios the guidelines
OAB (68 men) or without OAB (76). All men were given a three-month recommend both antimuscarinics and α-blockers; for BOO alone the
course of doxazosin. In patients with no symptomatic improvement, treatment is α-blockers, plus α-reductase inhibitors if the gland is a lot
tolterodine was added for an additional three months. As expected, larger and prostate-specific antigen levels are high.
treatment response after the first course of doxazosin – as measured
by a three-point reduction in their International Prostate Symptom Failure to respond to therapy leaves mostly surgical or minimally invasive
therapeutic options. When BOO is surgically treated, storage symptoms
improve – although to a lesser extent than voiding symptoms.
Transurethral resection of the prostate (TURP) is not guaranteed to cure
Men with lower urinary tract symptoms urgency, frequency and nocturia, which persist in 19% of men. Many
are predominantly treated with benign
report a return of storage symptoms after the initial resolution of LUTS.
Although clinical data on minimally invasive surgical treatments (MISTs)
prostatic hyperplasia agents rather than
demonstrate short-term reduction of LUTS, symptomatic improvement
with overactive bladder agents.
diminishes over time.
20,21
Score – was not uniform for all men. Of the men with BOO alone,
Antimuscarinics should be considered a
79% registered an improvement in their condition, compared with
reasonable treatment approach for lower
only 35% of men with a mixed condition. In those patients with no
improvement, 38% with BOO and 73% with BOO and OAB improved
urinary tract symptoms patients with
after tolterodine was added. AUR developed in only two of the 60
persistent overactive bladder symptoms.
men treated with the combined therapy. Thus, OAB symptoms may
persist when men are treated for LUTS associated with BOO but not
for OAB. Overall, this combination of approaches benefited most men
with BOO with or without OAB. Conclusion
Many patients with LUTS are treated with α-blockers, but they still have
There are new guidelines available covering the treatment of LUTS in persistent OAB symptoms. LUTS in men is characterised by voiding
older men: the 5th International Consultation on New Developments in symptoms and bothersome OAB symptoms. Prevalence of LUTS that
Prostate Cancer and Prostate Diseases. These illustrate the decision- include OAB symptoms is similar in men and women. Underlying pathology
making process that a specialist should follow for specialised of LUTS may be caused by the bladder or prostate. LUTS from different
management of persistent, bothersome LUTS after basic management underlying abnormalities may respond differently to drug therapy. Men
has failed. The first step includes a series of recommended tests, with LUTS historically receive diagnoses of BPH and are treated with
including validated questionnaires, calculation of the frequent volume α-blockers, leaving a subset of patients still bothered by persistent OAB
chart and flow rate recording and measurement of residual urine. This symptoms. Antimuscarinics should be considered a reasonable treatment
can help determine whether the fundamental problem is either OAB or approach for LUTS patients with persistent OAB symptoms. ■
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66 EUROPEAN GENITO-URINARY DISEASE 2007
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