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Male lower urinary tract symptoms: how do symptoms guide our choice of treatment?

Gravas, Stavros; Melekos, Michael D

doi: 10.1097/MOU.0b013e32831505fe
Benign prostatic hyperplasia: Edited by Jean de la Rosette

Purpose of review Lower urinary tract symptoms (LUTS) include voiding, storage, and postmicturition symptoms whereas in addition LUTS and sexual dysfunction are highly prevalent in aging men. The present article investigates how symptoms can guide our initial therapeutic approach to male LUTS and provides the recent data on the current treatment options.

Recent findings Recent studies suggest that not all male LUTS are associated with prostate pathology and that bladder plays a role in the development of LUTS and especially in storage symptoms. In addition to the traditional drug classes including α-blockers and 5α-reductase inhibitors, there is an increasing flow of data on the use of anticholinergics and phosphodiesterase type 5 inhibitors. Available studies provide high-level evidence on the efficacy and safety of these medical treatments. The upcoming data are beginning to shape new strategies for the initial management of male LUTS.

Summary Male LUTS have a complex nature and there is an overlap of storage and voiding symptoms. Weighing of storage versus voiding symptoms is a decisive factor for the selection of medical treatment. In addition, assessment of specific voiding and prostate parameters and the status of patient's sexual function may guide our choice.

Department of Urology, University Hospital of Larissa, Larissa, Greece

Correspondence to Stavros Gravas, Department of Urology, University Hospital of Larissa, Feidiou 6-8, 412 21 Larissa, Greece Tel: +30 2410 555296; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.