Treatment of Concomitant OAB and BPH

Abstract

The etiology of men's lower urinary tract storage and voiding symptoms involves a contribution from both detrusor and outlet. As such, treatment of benign prostatic enlargement (BPE) ± benign prostatic obstruction (BPO) with standard alpha-adrenergic blockade and 5-alpha reductase inhibitor therapy may leave a population of men with persistent and bothersome urinary storage symptoms. An abundance of adequately powered, randomized, placebo-controlled trials indicate that the use of antimuscarinics and beta-3 adrenergic agonists, either alone or in combination with standard BPE/BPO therapy, leads to improvement in storage symptoms. At the same time, metrics associated with urinary emptying, such as maximum flow rate, post-void residual urinary volume, and incidence of treatment-associated urinary retention, appear to be stable and not significantly impacted by the addition of antimuscarinics.

E‐cadherin is downregulated in benign prostatic hyperplasia and required for tight junction formation and permeability barrier in the prostatic epithelial cell monolayer

“…1 Although it is not life-threatening, BPH symptoms significantly impact the quality of life. 2 Furthermore, BPH treatment costs society more than $4 billion annually. 3 As male life expectancy increases, the number of men affected by BPH is expected to increase.…”

Intravesical prostatic protrusion does not compromise the therapeutic effects of Mirabegron in male patients with overactive bladder

“…Our study found no difference in adverse event rates between our two IPP groups. Moreover, for male LUTS patient, a combination of alpha blocker and antimuscarinics for storage symptom rather than antimuscarinics monotherapy is the generally accepted approach because of the concern of impairment of bladder contractility with antimuscarinics 2,19 . There have been a few studies investigating the efficacy of antimuscarinics monotherapy in male patients with BOO and OAB symptoms 20,21 .…”

Intravesical prostatic protrusion is not always the same shape: Evaluation by preoperative cystoscopy and outcome in HoLEP

“…A computational fluid dynamic study has shown that IPP predisposed to prostate deformation causes constriction of the prostatic urethra . IPP has been considered to cause a “ball‐valve” effect during voiding . Strong bladder contraction can open a channel of the lateral lobe but aggravate obstruction by the middle lobe.…”