OBJECTIVETo assess the safety and efficacy of anticholinergics in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by a systematic review of published reports and a meta-analysis of the reported outcomes. METHODSWe searched Medline, Embase and Cochrane databases , and hand-searched relevant reference lists and conference proceedings, for studies on the use of anticholinergics in men with BPH or bladder outlet obstruction. Eligible studies were assessed for quality and foreign language studies were translated. We collected data on all reported outcomes, conducted metaanalyses on the maximum urinary flow rate (Q max ), postvoid residual urine volume (PVR) and volume at first contraction, and calculated the acute urinary retention (AUR) rate. We used sensitivity analysis to confirm the findings. RESULTSWe identified five randomized controlled trials (RCTs) and 15 observational studies. Four RCTs incorporating 633 patients were included in the meta-analyses. Anticholinergics did not significantly alter Q max (0.1 mL/s, 95% confidence interval, CI, 0.6-0.7). The PVR was increased by 11.6 mL (95% CI 4.5-18.6) although there was no significant difference between AUR rates. The total International Prostate Symptom Scores (IPSS) were not significantly different, but there were improvements for IPSS storage subscores in one RCT. The AUR rate was 0.3% at the 12-week follow-up in 365 men in the RCTs and observational studies. CONCLUSIONAnticholinergic use in men with LUTS suggestive of BPH appears to be safe. Further studies are required to establish efficacy with a suitable precision.

Unilateral renal cystic disease (URCD) is a rare condition, with pathological features indistinguishable from autosomal dominant polycystic kidney disease (ADPKD). In contrast to this condition, however, URCD is not inherited, is not associated with progressive deterioration in renal function, and is unilateral. We present a case of URCD associated with polycythaemia, which showed resolution following nephrectomy. Secondary polycythaemia has not previously been reported in cases of URCD, but may be hypothesised to be a result of excess erythropoietin production.

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Both lower urinary tract symptoms associated with benign prostatic hyperplasia and erectile dysfunction are highly prevalent in the aging male population, a prevalence that increases with age. Evidence now suggests there is an independent association between these two complaints, increasing the likelihood that men presenting with either will suffer coexistent benign prostatic hyperplasia/lower urinary tract symptoms and erectile dysfunction. Treating these men presents both pitfalls and opportunities to the physician. By treating pathophysiological pathways common to both, whilst avoiding medication adversely affecting sexual function, optimal improvements in symptomatology and quality of life can be achieved. This review examines the relationship between these two pathologies and the implications for pharmacological intervention.Lower urinary tract symptoms (LUTS) affect over 50% of the male population aged over 60 years, an incidence which increases with age and is largely attributed to benign prostatic hyperplasia (BPH).Incidence of sexual dysfunction (SD) is also particularly high in this group of patients, and is increasingly recognized as a source of significant concern and loss of quality of life, even within older age groups [1]. SD incorporates not only erectile dysfunction (ED), but also impairment of other components of sexual function such as ejaculation, orgasm, sexual drive and sexual satisfaction, factors considered highly significant to overall sexual function.These two conditions were originally thought to be independent of each other and attributed to aging, but recent studies suggest an association underpinned by a common pathophysiological etiology.This has important implications for the management of men with either BPH/LUTS or ED, and particularly for those with both. Medical intervention for either condition affects the other, with potential for both exacerbation and improvement of symptoms [2]. An understanding of both disease states is therefore important in the treatment of either and is reviewed here, along with common treatment options. Association between LUTS & SD EpidemiologyIn 1996, Macfarlane surveyed a sample of the French population [3], noting low sexual life satisfaction scores with increasing age and severity of LUTS, and found the association persisted even after controlling for age. These findings have been confirmed by subsequent studies (such as the UrEpik study [4] and the Cologne Male Survey [5]), which demonstrate that LUTS are independent risk factors for ED.The clinical significance of this association was underscored when the Alf-One study group also reported a relationship between ED and LUTS severity in clinic attendees [6]. In this group of men, with relatively high mean age and LUTS severity, they found a high prevalence of ED (62%), and identified age and LUTS as the main predictors of the condition.However, perhaps the most important study to date to examine this has been the Multinational Survey of the Aging Male [7]. This large, multinational survey gathered...