Drug treatment for lower urinary tract symptoms

Ji-Yeon Han; Myung-Soo Choo

doi:10.5124/jkma.2011.54.6.637

J Korean Med Assoc > Volume 54(6); 2011 > Article

Han and Choo: Drug treatment for lower urinary tract symptoms

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2011; 54(6): 637-645.

Published online: June 10, 2011

DOI: http://dx.doi.org/10.5124/jkma.2011.54.6.637

Drug treatment for lower urinary tract symptoms

Ji-Yeon Han, MD, Myung-Soo Choo, MD

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Myung-Soo Choo, mschoo@amc.seoul.kr

Received February 07, 2011 Accepted February 21, 2011

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lower urinary tract symptoms (LUTS) are classified into three groups: storage, voiding, and post-micturition symptoms. The most popular causes of LUTS are benign prostatic hyperplasia (BPH) and overactive bladder (OAB). Although BPH is a pathologic term, clinically, we use this when patients have LUTS due to benign prostatic enlargement and obstruction. OAB is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. Currently α1-adrenoceptor antagonists are the most common drug treatment for BPH, and are thought to act by relaxing the prostatic smooth muscle. They are all effective for the treatment of LUTS/BPH. 5α-reductase inhibitors, such as fiansteride and dutasteride, are another treatment option for BPH symptoms, which reduce the prostatic volume by inducing epithelial atrophy. Long-term combination therapy with alpha-1-blockers and 5α-reductase inhibitors reduces the risk of the overall clinical progression of BPH significantly more than does treatment with either drug alone. Antimuscarinics are the mainstay for the treatment of OAB. Antimuscarinics competitively block muscarinic receptors of all subtypes but with variations in selectivity for the different subtypes. When they are used for the treatment of OAB, they are active during the storage phase of the bladder, with little or no effect on voiding contractions. Desmopressin acetate is a synthetic analogue of Arginin vasopressin, which has been proven effective for the treatment of nocturnal polyuria in LUTS.

Benign prostatic hyperplasia; Drug treatment; Overactive bladder

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Figure 1

Cumulative incidence of progression of benign prostatic hyperplasia in Medical Therapy of Prostatic Symptoms study. Progression was defined by an increase of at least 4 points over base line in the American Urological Association symptom score, acute urinary retention, urinary incontinence, renal insufficiency, or recurrent urinary tract infection. P-values are for the comparison with placebo. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. (From McConnell JD, et al. N Engl J Med 2003; 349: 2387-2398, with permission from Massachusetts Medical Society) [15].