Hyperactive Bladder in Men: Modern Recommendations and Practical Approaches to Diagnosis and Treatment

Abstract

An analysis of modern recommendations of the European Association of Urologists (EAU) regarding diagnosis and treatment options for overactive bladder (OAB) in men was carried out, taking into account real practice. The article discusses the general principles of diagnosis and treatment of non-neurogenic male lower urinary tract symptoms (LUTS) in the case where the predominant clinical features are urgency, pollakiuria, nocturia, which can be combined with urinary incontinence – complaints typical of GSM. Approaches to the treatment of such patients are still not clearly defined, and the effectiveness of treatment does not always satisfy both doctors and patients. It is indicated that in recent years, doctors have received completely new treatment options for this disease in men. In addition to adrenoblockers (AB) and cholinolytics (HL), phosphodiesterase-5 inhibitors (IPDE) and beta-3 adrenomimetics (BAM) were added, which showed their effectiveness and safety not only in women, but also in men. In addition, new options for combined treatment appeared in the recommendations – in addition to AB+HL, a combination of AB+IPDE and HL+BAM is possible. The article discusses various groups of drugs and their combinations recommended for the treatment of LUTS, the specifics of their use and possible side effects, especially the risks of urinary retention in men with infravesical obstruction. It is emphasized that the EAU currently recommends the use of HL in men with moderate and severe LUTS, who mainly have symptoms of accumulation with a residual urine of no more than 150 ml. It is recommended to determine the patient’s residual urine after a week of taking HL. The practical aspects of choosing the category of patients to be treated with certain drugs (or their combinations) are discussed, taking into account the possible side effects of each of the treatment options.