Pharmacology of the lower urinary tract: update on LUTS treatment

Abstract

The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor agonists. However, different combinations have been investigated, and the long-term use of these compounds has raised new concerns about adherence and safety. This review summarizes the current state of pharmacology for LUTS, and presents a thorough discussion of the possible challenges concerning their future use. In this narrative review, we analyze the most recent articles related to LUTS pharmacotherapy, after an initial review of mechanisms of bladder function relevant in present clinical practice. The main problems with pharmacotherapy in LUTS are associated with its moderate efficacy, low persistence on treatment, and the incidence of short- and long-term adverse events (AE) associated with some compounds. The long-term AE, such as cognitive impairment in the elderly vulnerable patients associated with antimuscarinic drugs or persistent erectile dysfunction in sexually active men after treatment with 5-α-reductase inhibitors (5-ARI), are some of the problems addressed in this review. Combination therapy taking advantage of the synergistic mechanisms of action between some classes of compounds may overcome AE associated with dose escalation. LUTS pharmacotherapy offers moderate results to most patients but not a full cure. The use of combination drugs to achieve better clinical results, reduce AE and improve both efficacy and adherence, will be used more frequently in the future. The recently raised concern on potential long-term irreversible AE associated with some of these drugs, like antimuscarinics and 5-ARI, are critically important and require further investigation.

Extract from Cucurbita pepo improves BPH symptoms without affecting sexual function: a 24-month noninterventional study

“…On the other hand, adherence to any medical therapy decreases over time in LUTS/BPH patients. Indeed, recent reported rates for alpha-blockers and combination therapy at 1 year were just 39.2% and 45.6%, respectively [ 30 , 31 ]. Compared to this, the adherence rate in our study indicates a good acceptance of PSE by patients who had started it.…”

Effects of 5-alpha reductase inhibitors prior to Holmium Laser Enucleation of the prostate: Does increased adenoma density result in prolonged morcellation times?

“…Medical management of BPH and LUTS includes selective and nonselective alpha-adrenergic antagonists, 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5-I), and combination therapy (5-ARIs and alpha-blockers) (2). 5-ARIs inactivate 5 alpha-reductase, an enzyme that converts testosterone into dihydrotestosterone (DHT) (3). DHT is the primary androgen involved in prostatic growth (4).…”

Prostatic Therapeutic Efficacy of LENILUTS®, a Novel Formulation with Multi-Active Principles

“…or voiding (obstruction) (hesitancy, weak or intermittent stream, etc. ), and present as various voiding dysfunctions [2]. While both men and women can be affected, LUTS is most often diagnosed in men affected by a benign enlargement of the prostate, known as Benign Prostatic Hyperplasia (BPH).…”