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Globally, male lower urinary tract symptoms (LUTS) are extremely common in patients of all ages, and different studies have shown that the overall prevalence of LUTS in the overall population ranges from 13% to 67%
.
However, only 26% to 38% of male patients with LUTS visit a doctor
.
A domestic study including 2080 male respondents showed that the prevalence of LUTS was 60.
3%, and men with all 3 International Continence Society (ICS) symptom groups accounted for 24.
2%
.
The most troubling symptoms are terminal dribbling and nocturia
.
Definition and symptoms Male LUTS refers to a group of symptoms related to the lower urinary tract, which may originate from the bladder, prostate, urethra, and/or adjacent pelvic organs, and may also originate from anatomical structures innervated by similar, psychological factors , Central nervous system lesions such as cerebrovascular sclerosis, Parkinson's disease, etc.
may also cause LUTS
.
LUTS includes three groups of symptoms: urinary symptoms (frequent urination, nocturia, excessive urination, dysesthesia including urgency during bladder filling, increased, decreased, loss of bladder filling, incontinence), and voiding symptoms (waiting to urinate, urinating Difficulty urinating, slow or intermittent urination, weak urine, narrowing of the urine stream, bifurcation or spraying of urine, terminal dribbling, urinary retention) and post-micturition symptoms (feeling of incomplete urination and urination after urination, urine dripping, urgency, etc.
)
.
Common causes of LUTS Benign prostatic hyperplasia (BPH): It is the most common benign disease that causes urination disorders in middle-aged and elderly men
.
Urodynamically, the main manifestation is bladder outlet obstruction (BOO), and the symptoms are mainly LUTS.
About 50% of men with histologically diagnosed BPH are associated with moderate to severe LUTS
.
Prostatitis and seminal vesiculitis: the two can exist independently or at the same time.
They are common diseases of urology andrology and the common cause of LUTS
.
Urinary tract infection: Symptoms include symptoms and signs related to the genitourinary tract, such as fever, frequent urination, urgency, dysuria, dysuria, pyuria,
etc.
Non-specific infections of the urinary system and specific infections such as urinary tract tuberculosis and non-gonococcal urethritis can cause LUTS symptoms
.
Overactive Bladder (OAB): refers to a group of symptoms characterized by urinary urgency, often accompanied by symptoms of frequent urination and nocturia, with or without urge urinary incontinence (UUI), without evidence of urinary tract infection or other clear pathological changes
.
OAB can be urodynamically manifested as detrusor overactivity (DO) or as other forms of urethral-bladder dysfunction
.
Nocturia: is an extremely common clinical symptom, which refers to more than one urination at night
.
It is characterized by the need to wake up to urinate during the main sleep period, and sleep or intentional sleep after each urination
.
Excessive nocturnal urine output, decreased bladder capacity, and OAB can lead to nocturia
.
Neurogenic bladder: It is a lower urinary tract dysfunction such as detrusor hypercontraction or detrusor atony or even non-contraction caused by the disorder of the neural control mechanisms regulating bladder function at all levels
.
Detrusor Hypofunction: A reduction in the strength and/or duration of bladder detrusor contractions, resulting in prolonged bladder emptying and/or inability to achieve complete bladder emptying within the normal time period
.
This is a common cause of LUTS
.
Urethral strictures: Trauma and iatrogenic injuries and urinary tract infections are the 3 most common causes of urethral strictures
.
The most common symptoms in patients with urethral strictures are lower urinary tract symptoms, urinary retention, or urinary tract infection
.
Bladder tumor: Some patients with bladder cancer may have frequent urination, urgency and dysuria as the first symptoms, which are often related to diffuse carcinoma in situ or muscle invasive bladder cancer
.
Bladder tumors that invade the bladder neck or posterior urethra can cause bladder outlet obstruction, resulting in difficulty urinating
.
Lower ureteral calculi: stones in the inner part of the bladder wall or incarcerated at the opening of the bladder can stimulate the autonomic nerves in the bladder triangle, leading to LUTS symptoms such as frequent urination, urgency, and dysuria.
Bladder foreign bodies: foreign bodies in the lower urinary tract are not uncommon , Various materials such as wires, plastics, pen barrels, safety needles, magnetic beads, etc.
have been reported
.
Psychological disorders: Psychological factors play an important role in the lower urinary tract symptoms of patients
.
When the autonomic nervous system is disturbed, it will increase the excitability of the sympathetic nerves of the pelvic floor and urethral sphincter, resulting in increased pressure on the urethra, resulting in the inability of the detrusor to function effectively, and thus aggravating dysuria
.
Others: Bladder stones, interstitial cystitis/painful bladder syndrome, glandular cystitis, pelvic lipodystrophy, anorectal diseases such as perianal abscess, pelvic arteriosclerosis and central nervous system lesions can all cause different degrees of LUTS symptoms
.
Watchful waiting for the treatment of LUTS For patients with mild LUTS (IPSS≤7) or even moderate LUTS (IPSS≥8) who can exclude infections, tumors, stones, foreign bodies and other definite diseases and secondary damage, if the quality of life is not significantly affected , you can choose to watch and wait
.
Most patients with mild to moderate LUTS have stable symptoms for many years and rarely progress
.
Patients under watchful waiting should receive patient education and regular follow-up monitoring to avoid disease progression and related complications
.
Medications or surgical intervention should be given when necessary
.
Distressing symptoms and increased residual urine volume were the strongest predictors of failure to watchful waiting
.
Drug therapy should be based on the main symptom characteristics of different patients, targeted selection of therapeutic drugs and combination programs
.
The drugs that mainly improve the symptoms of urine storage period include M receptor antagonists, β3 receptor agonists, antibiotics, antidiuretic hormone analogs,
etc.
The main drugs to improve urinary symptoms are α-blockers, 5α-reductase inhibitors (5-ARIs), phosphodiesterase 5 inhibitors (PDE5Is), and plant preparations
.
Alpha-blockers are currently clinically used drugs that are mainly selective alpha-1 receptor blockers (doxazosin, alfuzosin, terazosin) and highly selective alpha-1 receptor blockers (tamsuol).
rosin, napidil, silodosin)
.
Symptoms improve within hours to days after alpha1-blocker treatment
.
M-receptor antagonists commonly used M-receptor blockers include tolterodine, solifenacin, and propaverine
.
In patients with moderate-to-severe LUTS and predominantly bladder storage symptoms, M-receptor antagonist monotherapy significantly improved urinary urgency, UUI, and 24-h voiding frequency
.
The β3 receptor agonist Mirabegron is the first β3 receptor agonist approved by the FDA for the treatment of OAB, which can significantly improve urinary storage LUTS such as urinary frequency, urgency and UUI symptoms
.
Antibiotics Antibiotics should be used for LUTS during voiding caused by urinary tract infection
.
Commonly used first-line treatment options include levofloxacin or second- and third-generation cephalosporins
.
The vast majority of patients with acute uncomplicated cystitis can turn negative for urinary bacteria after short-course therapy, and the symptoms of LUTS can disappear
.
The antidiuretic hormone analog Desmopressin acetate is an antidiuretic hormone analog that is currently used for the treatment of nocturnal polyuria
.
The usual dose is 0.
2 to 0.
4 mg administered 1 hour before bedtime
.
5-ARIs There are currently two 5-ARIs in clinical use: dutasteride and finasteride
.
For men with moderate to severe LUTS, enlarged prostate (>40ml) and/or elevated PSA level (>1.
4-1.
6μg/L), 5-ARIs should be considered
.
5-ARIs can reduce IPSS, reduce prostate volume, increase Qmax, and reduce the risk of acute urinary retention and the need for surgery
.
The drug has a slow onset of action, so it is not suitable for short-term use
.
PDE5Is Europe has approved tadalafil for the clinical treatment of LUTS
.
Tadalafil can significantly reduce the symptoms of LUTS
.
Botanical preparations Botanical preparations such as saw palmetto fruit extract, lycopene, etc.
, have non-specific anti-inflammatory, anti-edema, promotion of bladder detrusor contraction and urethral smooth muscle relaxation
.
Suitable for the treatment of BPH/LUTS
.
Combination therapy can choose α1 blocker + 5-ARIs, α1 receptor blocker + M receptor antagonist, α1 receptor blocker + PDE5Is, and 5-ARIs + PDE5Is according to the symptoms of different patients.
Even a combination of multiple drugs is used
.
However, when using a non-highly selective a1 receptor blocker (doxazosin or terazosin) in combination, it is necessary to be alert to the occurrence of orthostatic hypotension, pay attention to the interval between different drugs, and reduce the dosage of PDE5Is
.
Reference source: Chinese Expert Consensus on Diagnosis and Treatment of Male Lower Urinary Tract Symptoms.
Chinese Journal of Andrology.
doi: 10.
13263 /j.
cnki.
nja.
2021．12.
014
.
However, only 26% to 38% of male patients with LUTS visit a doctor
.
A domestic study including 2080 male respondents showed that the prevalence of LUTS was 60.
3%, and men with all 3 International Continence Society (ICS) symptom groups accounted for 24.
2%
.
The most troubling symptoms are terminal dribbling and nocturia
.
Definition and symptoms Male LUTS refers to a group of symptoms related to the lower urinary tract, which may originate from the bladder, prostate, urethra, and/or adjacent pelvic organs, and may also originate from anatomical structures innervated by similar, psychological factors , Central nervous system lesions such as cerebrovascular sclerosis, Parkinson's disease, etc.
may also cause LUTS
.
LUTS includes three groups of symptoms: urinary symptoms (frequent urination, nocturia, excessive urination, dysesthesia including urgency during bladder filling, increased, decreased, loss of bladder filling, incontinence), and voiding symptoms (waiting to urinate, urinating Difficulty urinating, slow or intermittent urination, weak urine, narrowing of the urine stream, bifurcation or spraying of urine, terminal dribbling, urinary retention) and post-micturition symptoms (feeling of incomplete urination and urination after urination, urine dripping, urgency, etc.
)
.
Common causes of LUTS Benign prostatic hyperplasia (BPH): It is the most common benign disease that causes urination disorders in middle-aged and elderly men
.
Urodynamically, the main manifestation is bladder outlet obstruction (BOO), and the symptoms are mainly LUTS.
About 50% of men with histologically diagnosed BPH are associated with moderate to severe LUTS
.
Prostatitis and seminal vesiculitis: the two can exist independently or at the same time.
They are common diseases of urology andrology and the common cause of LUTS
.
Urinary tract infection: Symptoms include symptoms and signs related to the genitourinary tract, such as fever, frequent urination, urgency, dysuria, dysuria, pyuria,
etc.
Non-specific infections of the urinary system and specific infections such as urinary tract tuberculosis and non-gonococcal urethritis can cause LUTS symptoms
.
Overactive Bladder (OAB): refers to a group of symptoms characterized by urinary urgency, often accompanied by symptoms of frequent urination and nocturia, with or without urge urinary incontinence (UUI), without evidence of urinary tract infection or other clear pathological changes
.
OAB can be urodynamically manifested as detrusor overactivity (DO) or as other forms of urethral-bladder dysfunction
.
Nocturia: is an extremely common clinical symptom, which refers to more than one urination at night
.
It is characterized by the need to wake up to urinate during the main sleep period, and sleep or intentional sleep after each urination
.
Excessive nocturnal urine output, decreased bladder capacity, and OAB can lead to nocturia
.
Neurogenic bladder: It is a lower urinary tract dysfunction such as detrusor hypercontraction or detrusor atony or even non-contraction caused by the disorder of the neural control mechanisms regulating bladder function at all levels
.
Detrusor Hypofunction: A reduction in the strength and/or duration of bladder detrusor contractions, resulting in prolonged bladder emptying and/or inability to achieve complete bladder emptying within the normal time period
.
This is a common cause of LUTS
.
Urethral strictures: Trauma and iatrogenic injuries and urinary tract infections are the 3 most common causes of urethral strictures
.
The most common symptoms in patients with urethral strictures are lower urinary tract symptoms, urinary retention, or urinary tract infection
.
Bladder tumor: Some patients with bladder cancer may have frequent urination, urgency and dysuria as the first symptoms, which are often related to diffuse carcinoma in situ or muscle invasive bladder cancer
.
Bladder tumors that invade the bladder neck or posterior urethra can cause bladder outlet obstruction, resulting in difficulty urinating
.
Lower ureteral calculi: stones in the inner part of the bladder wall or incarcerated at the opening of the bladder can stimulate the autonomic nerves in the bladder triangle, leading to LUTS symptoms such as frequent urination, urgency, and dysuria.
Bladder foreign bodies: foreign bodies in the lower urinary tract are not uncommon , Various materials such as wires, plastics, pen barrels, safety needles, magnetic beads, etc.
have been reported
.
Psychological disorders: Psychological factors play an important role in the lower urinary tract symptoms of patients
.
When the autonomic nervous system is disturbed, it will increase the excitability of the sympathetic nerves of the pelvic floor and urethral sphincter, resulting in increased pressure on the urethra, resulting in the inability of the detrusor to function effectively, and thus aggravating dysuria
.
Others: Bladder stones, interstitial cystitis/painful bladder syndrome, glandular cystitis, pelvic lipodystrophy, anorectal diseases such as perianal abscess, pelvic arteriosclerosis and central nervous system lesions can all cause different degrees of LUTS symptoms
.
Watchful waiting for the treatment of LUTS For patients with mild LUTS (IPSS≤7) or even moderate LUTS (IPSS≥8) who can exclude infections, tumors, stones, foreign bodies and other definite diseases and secondary damage, if the quality of life is not significantly affected , you can choose to watch and wait
.
Most patients with mild to moderate LUTS have stable symptoms for many years and rarely progress
.
Patients under watchful waiting should receive patient education and regular follow-up monitoring to avoid disease progression and related complications
.
Medications or surgical intervention should be given when necessary
.
Distressing symptoms and increased residual urine volume were the strongest predictors of failure to watchful waiting
.
Drug therapy should be based on the main symptom characteristics of different patients, targeted selection of therapeutic drugs and combination programs
.
The drugs that mainly improve the symptoms of urine storage period include M receptor antagonists, β3 receptor agonists, antibiotics, antidiuretic hormone analogs,
etc.
The main drugs to improve urinary symptoms are α-blockers, 5α-reductase inhibitors (5-ARIs), phosphodiesterase 5 inhibitors (PDE5Is), and plant preparations
.
Alpha-blockers are currently clinically used drugs that are mainly selective alpha-1 receptor blockers (doxazosin, alfuzosin, terazosin) and highly selective alpha-1 receptor blockers (tamsuol).
rosin, napidil, silodosin)
.
Symptoms improve within hours to days after alpha1-blocker treatment
.
M-receptor antagonists commonly used M-receptor blockers include tolterodine, solifenacin, and propaverine
.
In patients with moderate-to-severe LUTS and predominantly bladder storage symptoms, M-receptor antagonist monotherapy significantly improved urinary urgency, UUI, and 24-h voiding frequency
.
The β3 receptor agonist Mirabegron is the first β3 receptor agonist approved by the FDA for the treatment of OAB, which can significantly improve urinary storage LUTS such as urinary frequency, urgency and UUI symptoms
.
Antibiotics Antibiotics should be used for LUTS during voiding caused by urinary tract infection
.
Commonly used first-line treatment options include levofloxacin or second- and third-generation cephalosporins
.
The vast majority of patients with acute uncomplicated cystitis can turn negative for urinary bacteria after short-course therapy, and the symptoms of LUTS can disappear
.
The antidiuretic hormone analog Desmopressin acetate is an antidiuretic hormone analog that is currently used for the treatment of nocturnal polyuria
.
The usual dose is 0.
2 to 0.
4 mg administered 1 hour before bedtime
.
5-ARIs There are currently two 5-ARIs in clinical use: dutasteride and finasteride
.
For men with moderate to severe LUTS, enlarged prostate (>40ml) and/or elevated PSA level (>1.
4-1.
6μg/L), 5-ARIs should be considered
.
5-ARIs can reduce IPSS, reduce prostate volume, increase Qmax, and reduce the risk of acute urinary retention and the need for surgery
.
The drug has a slow onset of action, so it is not suitable for short-term use
.
PDE5Is Europe has approved tadalafil for the clinical treatment of LUTS
.
Tadalafil can significantly reduce the symptoms of LUTS
.
Botanical preparations Botanical preparations such as saw palmetto fruit extract, lycopene, etc.
, have non-specific anti-inflammatory, anti-edema, promotion of bladder detrusor contraction and urethral smooth muscle relaxation
.
Suitable for the treatment of BPH/LUTS
.
Combination therapy can choose α1 blocker + 5-ARIs, α1 receptor blocker + M receptor antagonist, α1 receptor blocker + PDE5Is, and 5-ARIs + PDE5Is according to the symptoms of different patients.
Even a combination of multiple drugs is used
.
However, when using a non-highly selective a1 receptor blocker (doxazosin or terazosin) in combination, it is necessary to be alert to the occurrence of orthostatic hypotension, pay attention to the interval between different drugs, and reduce the dosage of PDE5Is
.
Reference source: Chinese Expert Consensus on Diagnosis and Treatment of Male Lower Urinary Tract Symptoms.
Chinese Journal of Andrology.
doi: 10.
13263 /j.
cnki.
nja.
2021．12.
014
