New concepts for the treatment of male lower urinary tract symptoms

Füllhase, Claudius; Hakenberg, Oliver W.

doi:10.1097/mou.0000000000000126

Cited by 12 publications

(12 citation statements)

References 79 publications

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“…BPH is mainly a histological diagnosis, the clinical counterparts of which are benign prostate enlargement, and benign prostate obstruction (Abrams, ). The two clinical entities are characterized by a progressive development of symptoms (lower urinary tract symptoms, LUTS) – that are only partially derived from the prostate enlargement – which can affect quality of life and sexual function (Corona et al ., ; Gacci et al ., , ; Vignozzi et al ., ; Füllhase & Hakenberg, ). BPH‐associated LUTS are probably the most common urological conditions of aging men, with an estimated overall prevalence of 10.3%, and an overall incidence rate of 15 per 1000 males per year with even higher rates in older individuals (Verhamme et al ., ).…”

Section: Introductionmentioning

confidence: 99%

“…BPH‐associated LUTS are probably the most common urological conditions of aging men, with an estimated overall prevalence of 10.3%, and an overall incidence rate of 15 per 1000 males per year with even higher rates in older individuals (Verhamme et al ., ). Medical treatment is mainly based on the use of alpha‐blockers and 5‐alpha reductase inhibitors (5ARIs; Füllhase & Hakenberg, ; Yuan et al ., ). More recently, phosphodiesterase type 5 inhibitors (PDE5i), and tadalafil in particular, have been demonstrated to improve LUTS/BPH, although their role in reducing obstructive symptoms is more conflicting (Gacci et al ., ).…”

Section: Introductionmentioning

confidence: 99%

“…More recently, phosphodiesterase type 5 inhibitors (PDE5i), and tadalafil in particular, have been demonstrated to improve LUTS/BPH, although their role in reducing obstructive symptoms is more conflicting (Gacci et al ., ). A large body of evidence has documented that alpha‐blockers and 5ARIs can improve not only LUTS but also urinary flow (Füllhase & Hakenberg, ; Yuan et al ., ). However, the use of these medications has often been associated with a further worsening of sexual function.…”

Section: Introductionmentioning

confidence: 99%

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Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

et al. 2017

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Despite their efficacy in the treatment of benign prostatic hyperplasia, the popularity of inhibitors of 5α-reductase (5ARIs) is limited by their association with adverse sexual side effects. The aim of this study was to review and meta-analyze currently available randomized clinical trials evaluating the rate of sexual side effects in men treated with 5ARIs. An extensive Medline Embase and Cochrane search was performed including the following words: 'finasteride', 'dutasteride', 'benign prostatic hyperplasia'. Only placebo-controlled randomized clinical trials evaluating the effect of 5ARI in subjects with benign prostatic hyperplasia were considered. Of 383 retrieved articles, 17 were included in this study. Randomized clinical trials enrolled 24,463 in the active and 22,270 patients in the placebo arms, respectively, with a mean follow-up of 99 weeks and mean age of 64.0 years. No difference was observed between trials using finasteride or dutasteride as the active arm considering age, trial duration, prostate volume or International Prostatic Symptoms Score at enrollment. Overall, 5ARIs determined an increased risk of hypoactive sexual desire [OR = 1.54 (1.29; 1.82); p < 0.0001] and erectile dysfunction [OR = 1.47 (1.29; 1.68); p < 0.0001]. No difference between finasteride and dutasteride regarding the risk of hypoactive sexual desire and erectile dysfunction was observed. Meta-regression analysis showed that the risk of hypoactive sexual desire and erectile dysfunction was higher in subjects with lower Q at enrollment and decreased as a function of trial follow-up. Conversely, no effect of age, low urinary tract symptom or prostate volume at enrollment as well as Q at end-point was observed. In conclusion, present data show that the use of 5ARI significantly increases the risk of erectile dysfunction and hypoactive sexual desire in subjects with benign prostatic hyperplasia. Patients should be adequately informed before 5ARIs are prescribed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

et al. 2017

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“…However, other investigators state that, apart from the old concept of mainly hormone-dependent prostate growth, new ideas about the cause of BPH include an inflammatory factor [22]. Therefore, materials presented at a satellite symposium entitled, “Inflammation and Prostatic Diseases: From Bench to Bedside,” held during the 2015 annual meeting of the European Association of Urology in Madrid, Spain, revealed that reducing chronic inflammation is a target for the treatment of BPH [23].…”

Section: Discussionmentioning

confidence: 99%

Positive Response to Thermobalancing Therapy Enabled by Therapeutic Device in Men with Non-Malignant Prostate Diseases: BPH and Chronic Prostatitis

Aghajanyan

Allen

2016

Diseases

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Background: The most common types of non-malignant prostate diseases are benign prostatic hyperplasia (BPH) and chronic prostatitis (CP). The aim of this study was to find out whether thermobalancing therapy with a physiotherapeutic device is effective for BPH and CP. Methods: During a 2.5-year period, 124 men with BPH over the age of 55 were investigated. Clinical parameters were tested twice: via the International Prostate Symptom Score (IPSS) and via ultrasound measurement of prostate volume (PV) and uroflowmetry maximum flow rate (Qmax), before and after six months of therapy. In 45 men with CP under the age of 55, the dynamics of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) were studied. Results: The results of the investigated index tests in men with BPH confirmed a decrease in IPSS (p < 0.001), a reduction in PV (p < 0.001), an increase in Qmax (p < 0.001), and an improvement of quality of life (QoL) (p < 0.001). NIH-CPSI scores in men with CP indicated positive dynamics. Conclusions: The observed positive changes in IPSS, PV, and Qmax in men with BPH and the improvement in NIH-CPSI-QoL in patients with CP after using a physiotherapeutic device for six months as mono-therapy, support the view that thermobalancing therapy with the device can be recommended for these patients. Furthermore, the therapeutic device is free of side effects.

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“…Conflicting results from several studies evaluating the role of anti-inflammatory drugs on BPH and LUTS are available in the literature, and thus clear recommendations cannot be drawn. 46 Moreover, a lot of available studies are characterized by their relatively short duration and lack of randomization and control group, and as such no high-quality data can be extracted from their analysis. 32 …”

Section: Treatment Modalities Currently Under Investigationmentioning

confidence: 99%

New therapeutic strategies for the treatment of male lower urinary tract symptoms

Dimitropoulos

Gravas

2016

RRU

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Male lower urinary tract symptoms (LUTS) are prevalent in the general population, especially in those of advanced age, and are characterized by notable diversity in etiology and presentation, and have been proven to cause various degrees of impairment on quality of life. The prostate has traditionally been regarded as the core cause of male LUTS. As a result, medical treatment aims to provide symptomatic relief and effective management of progression of male LUTS due to benign prostatic enlargement. In this context, α1-blockers, phosphodiesterase-5 inhibitors, and 5α-reductase inhibitors have long been used as monotherapies or in combination treatment to control voiding LUTS. There is accumulating evidence, however, that highlights the role of the bladder in the pathogenesis of male LUTS. Current research interests have shifted to bladder disorders, and medical management is aimed at the bladder. Muscarinic receptor antagonists and the newly approved β3-adrenergic agonist mirabegron aim to alleviate the most bothersome storage LUTS and thus improve quality of life. As voiding and storage LUTS frequently coexist, combination therapeutic strategies with α1-blockers and antimuscarinics or β3-agonists have been introduced to manage symptoms effectively. Anti-inflammatory agents, vitamin D3-receptor analogs, and cannabinoids represent treatment modalities currently under investigation for use in LUTS patients. Furthermore, luteinizing hormone-releasing hormone antagonists, transient receptor-potential channel blockers, purinergic neurotransmission antagonists, Rho-kinase inhibitors, and inhibitors of endothelin-converting enzymes could have therapeutic potential in LUTS management, but still remain in the experimental setting. This article reviews new strategies for the medical treatment of male LUTS, which are dictated by the potential role of the bladder and the risk of benign prostatic hyperplasia progression. Moreover, combination treatments and therapies currently under investigation are also presented.

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New concepts for the treatment of male lower urinary tract symptoms

Abstract: New concepts on BPH cause show interesting approaches, but are still in early stages. They carry, however, the highest prospect to bring up causal treatments. Some new compounds related to LUTS are on the verge to switch 'from bench to bedside'.

Cited by 12 publications

References 79 publications

Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

Positive Response to Thermobalancing Therapy Enabled by Therapeutic Device in Men with Non-Malignant Prostate Diseases: BPH and Chronic Prostatitis

New therapeutic strategies for the treatment of male lower urinary tract symptoms

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