Peculiarities of Dysuria Treatment in Men With Benign Prostatic Hyperplasia

Abstract

Objective of the work is to analyze the practical aspects of medical treatment of urination disorders in men with benign prostatic hyperplasia (BPH). Results. Recently, more and more patients with BPH are being treated conservatively due to the increased availability of drug therapy. Traditional alpha-blockers (AB) do not always have a sufficient effect in reducing dysuria in such patients. In recent years, a number of new treatment options have been introduced into the Guidelines of the European Association of Urology (EAU) for the diagnosis and treatment of non-neurogenic voiding disorders - phosphodiesterase 5 inhibitors and beta-3 adrenomimetics have been added to cholinolytics (CL). These groups of drugs have different mechanisms of action, and some of the recommended drugs (such as CL) help relax the bladder wall and have traditionally been used in women with symptoms of overactive bladder (OAB). CL has been well studied in this category of patients both in terms of safety and efficacy. At the same time, when used in men with BPH, especially in the presence of benign prostatic obstruction (BPO), there remains the question of safety in terms of worsening urination. Although most current studies do not demonstrate an increased risk of acute urinary retention as a side effect, a number of recommendations should be followed for safe treatment of such patients. It is recommended to use CL in patients with severe and moderate urinary disorders with a predominance of irritative symptoms. However, the size of the prostate gland is not a criterion for the use of CL. Conducting urodynamic studies is also not recommended to determine the necessity or safety of one or another treatment option, they are reserved only for complicated cases or when neurogenic urination disorders are suspected. Conclusions. Complex urodynamic studies are not routinely used, while uroflowmetry should be used as a method of general evaluation of urination efficiency, diagnosis of BPO and effectiveness of patient treatment. Residual urine should be determined before taking the drugs (it is recommended that it not exceed 150 ml) and after a week of treatment.