Testosterone replacement therapy and voiding dysfunction

Baas, Wesley; Köhler, Tobias

doi:10.21037/tau.2016.08.11

Cited by 18 publications

(11 citation statements)

References 76 publications

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“…In fact, recent reviews suggested testosterone may be beneficial for BPH/LUTS, possibly by increasing the expression and activity of nitric oxide synthase to achieve smooth muscle relaxation [38]. Testosterone deficiency may be a risk factor for BPH/ LUTS, suggesting a causal relationship between hypogonadism and the occurrence of BPH/LUTS [39]. A concern remains that testosterone therapy (TTh) may worse may worsen LUTS in patients.…”

Section: Discussionmentioning

confidence: 99%

The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis

Peng

Cao

et al. 2020

The Aging Male

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Objective: We performed this meta-analysis to assess the association between metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH). Method: We conducted extensive searches on the PubMed, Science and Cochrane Library to identify all articles. Outcomes including annual prostate growth rate, prostate volume (PV), International Prostate Symptom Score (IPSS), IPSS sub-scores (voiding and storage), prostatespecific antigen (PSA), maximum urine flow rate (Qmax), post-void residual urine volume (PVR) and quality of life (QoL) were assessed. Results: 21 studies with 15,317 patients were included. Patients with MetS had higher annual prostate growth rate [weighted mean difference (WMD) ¼ 0.79; p < .001], larger PV (WMD ¼ 2.62; p < .001), lower Qmax (WMD ¼ À0.48; p ¼ .001) and more PVR (WMD ¼ 8.28; p < .001). However, no significant differences were found between two groups in IPSS (WMD ¼ 0.20; p ¼ .37), IPSS-voiding (WMD ¼ À0.05; p ¼ .78), IPSS-storage (WMD ¼ À0.22; p ¼ .26), PSA (WMD ¼ 0.04; p ¼ .43), and QoL (WMD ¼ À0.01; p ¼ .70). Conclusions:The study suggested that MetS may be one of the risk factors for the clinical progress of BPH. However, further study is warranted to support these results.

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Section: Discussionmentioning

confidence: 99%

The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis

Peng

Cao

et al. 2020

The Aging Male

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“…On the other hand, preliminary evidence indicates that men with LUTS benefit from T treatment [ 116 ] and pilot studies have also shown that T therapy has a positive effect on LUTS men with TD [ 140 ]. In a recent review Baas and Köhler [ 150 ] suggested that T may be beneficial for BPH/LUTS, likely via increased expression and activity of nitric oxide synthase concomitant with smooth muscle relaxation. Concern remains that T therapy may worsen LUTS secondary to BPH, although few major adverse events have been reported with T treatment.…”

Section: Does Testosterone Therapy Improves Lower Urinary Tract Symptmentioning

confidence: 99%

Impact of Testosterone Deficiency and Testosterone Therapy on Lower Urinary Tract Symptoms in Men with Metabolic Syndrome

Traish

Johansen

2018

World J Mens Health

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Lower urinary tract function is modulated by neural, vascular and urethral and bladder structural elements. The pathophysiological mechanisms of lower urinary tract symptoms (LUTS) encompass prostate enlargement, alterations in urethra histological structure bladder fibrosis and alterations in pelvic neuronal and vascular networks, The complex pathophysiological relationship between testosterone (T) deficiency (TD) and the constellations LUTS, and metabolic dysfunction manifested in the metabolic syndrome (Met S) remains poorly understood. TD has emerged as one the potential targets by which Met S may contribute to the onset and development as well as worsening of LUTS. Because it has been recognized that treatment of men with Met S with T therapy ameliorates Met S components, it is postulated that T therapy may represent a therapeutic target in improving LUTS. Furthermore, the effect of TD on the prostate remains unclear, and often debatable. It is believed that T exclusively promotes prostate growth, however recent evidence has strongly contradicted this belief. The true relationship between benign prostatic hyperplasia, TD, and LUTS remains elusive and further research will be required to clarify the role of T in both benign prostatic hypertrophy (BPH) and LUTS as a whole. Although there is conflicting evidence about the benefits of T therapy in men with BPH and LUTS, the current body of literature supports the safety of using this therapy in men with enlarged prostate. As the population afflicted with obesity epidemic continues to age, the number of men suffering from Met S and LUTS together is expected to increase.

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“…This mechanism of T-induced NO smooth muscle relaxation is also reflected in the effect of phosphodiesterase-5 (PDE-5) inhibitors used as effective treatment of LUTS/BPH. While PDE-5 interacts with NOS with the effect to reduce NO production, the use of PDE-5 inhibitors consequently leads to an up-regulation of NO production [ 1 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The involvement of T in the lower urinary tract suggests a physiological correlation between T and LUTS. Lack of T may be a risk factor for LUTS/BPH suggesting a causal link between hypogonadism and incidence of LUTS/BPH [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Hypogonadal men with moderate-to-severe lower urinary tract symptoms have a more severe cardiometabolic risk profile and benefit more from testosterone therapy than men with mild lower urinary tract symptoms

Saad

Doros

Haider³

et al. 2018

Investig Clin Urol

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PurposeTo analyze data from an observational, prospective, cumulative registry study in 805 hypogonadal men stratified by mild or moderate-to-severe lower urinary tract symptoms (LUTS) according to International Prostate Symptom Score.Materials and MethodsA total of 412 men underwent testosterone therapy (TTh) with injectable testosterone undecanoate, 393 men served as untreated controls. Measures of urinary function, anthropometric and metabolic parameters were performed at least twice per year.ResultsData from 615 men with mild LUTS (253 treated, 362 untreated) and 190 with moderate-to-severe LUTS (159 treated, 31 untreated) were available. During a follow-up period of 8 years a significant improvement of LUTS was noted for all TTh-patients whereas the control-groups showed deterioration or fluctuation around initial values. Despite advancing age, TTh fully prevented worsening of symptoms. In parallel, a considerable improvement of anthropometric parameters, lipids and glycemic control, blood pressure, C-reactive protein, and quality of life was found. Moderate-to-severe LUTS was associated with worse cardiometabolic risk profile at baseline as well as worse cardiovascular outcomes during follow-up in comparison to mild LUTS. Effect size of TTh was more pronounced in men with moderate-to-severe than with mild LUTS.ConclusionsCorrecting hypogonadism by TTh is highly effective and safe for improving LUTS in hypogonadal men. TTh may also improve cardiometabolic risk and major adverse cardiovascular events.

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Testosterone replacement therapy and voiding dysfunction

Cited by 18 publications

References 76 publications

The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis

The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis

Impact of Testosterone Deficiency and Testosterone Therapy on Lower Urinary Tract Symptoms in Men with Metabolic Syndrome

Hypogonadal men with moderate-to-severe lower urinary tract symptoms have a more severe cardiometabolic risk profile and benefit more from testosterone therapy than men with mild lower urinary tract symptoms

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