Lower urinary tract symptoms

O The lower urinary tract symptoms and signs of benign prostatic hyperplasia are due to static, dynamic, or detrusor factors. The static factor refers to anatomic obstruction of the bladder neck caused by an enlarged prostate gland. The dynamic factor refers to excessive stimulation of a-adrenergic receptors in the smooth muscle of the prostate, urethra, and bladder neck. The detrusor factor refers to irritability of hypertrophied detrusor muscle as a result of long-standing bladder outlet obstruction. 

Surgical intervention should be reserved for patients with severe lower urinary tract symptoms of benign prostatic hyperplasia or those with complications of disease (such as recurrent urinary tract infections, renal failure, and bladder calculi). 

Chappie CR. Pharmacological therapy of benign prostatic hyperplasia/ lower urinary tract symptoms an overview for the practicing clinician. BJU Int 2004 94 738-744. 

Djavan B, Chappie C, Milani S, Marberger M. State of the art on the efficacy and tolerability of alpha, adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 2004 64 1081-1088. 

Milani S, Djavan B. Lower urinary tract symptoms suggestive of benign prostatic hyperplasia latest update on a, adrenoceptor antagonists. BJU Int 2005 95(Suppl 4) 29—36. 

Urinary incontinence (UI) is defined as the complaint of involuntary leakage of urine.1 It is often associated with other bothersome lower urinary tract symptoms such as urgency, increased daytime frequency, and nocturia. Despite its prevalence across the lifespan and in both sexes, it remains an underdetected and underreported health problem that can have significant negative consequences for the individual s quality of life. Patients with UI may be depressed due to a... 

Bladder dysfunction. Two whole-plant extracts of Cannabis sativa were administered to patients with advanced multiple sclerosis (MS) and refractory troublesome lower urinary tract symptoms. The patients... 

Early urodynamic effect. Permixon was administered to 75 patients with lower urinary tract symptoms resulting from mild-to-moderate BPH (mean IPSS 8.2), aged 52-78 years, at a dose of 160 mg twice daily for 9 weeks. Maximum urinary flow rate increased 6% (p < 0.001), and there was a reduction in detrusor pressure at maximum flow (12.8%, p < 0.001), opening detrusor pressure (12.6%, p < 0.001), and residual urine volume (12.6%, p < 0.05). The IPSS... 

Kuzmin, and R. R. Amdiy. Early urodynamic effects of the lipido-ste-rolic extract of Serenoa repens (Permixon ) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2000 3(3) 195-199. 

Biol Int 2001 25(11) 1117-1124. Gerber, G. S., D. Kuznetsov, B. C. Johnson, and J.D. Burstein. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology 2001 ... 

Finrozole is a nonsteroidal competitive aromatase inhibitor that is being evaluated in Phase II trials for the treatment of lower urinary tract symptoms associated with a reduced androgen/estrogen ratio in aging males associated with BPH. 

Lowe FC. Roie of the newer alpha,-adrenergic-receptor antagonists in the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. Clin Ther... 

Headache (60%), hot flashes (55%), depression (54%), diaphoresis (45%), sexual dysfunction (21%), decreased erection (18%), lower urinary tract symptoms (13%) Occasional (10%-5%)... 

Roehrborn CG, Schwinn DA Alphai-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol 2004 171 1029. [PMID 14767264]... 

Schwinn DA, Roehrborn CG. Alphal-adrenoceptor subtypes and lower urinary tract symptoms. Int J Urol 2008 15 193. [PMID 18304211]... 

Inaba M, Otani Y, Nishimura K, Takaha N, Okuyama A, Koga M, Azuma J, Kawase I, Kasayama S. Combination therapy with rofecoxib and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia. Metab Clin Exp 2005 54 55-9. 

Zlotta AR, Teillac P, Raynaud JP, Schulman CC. Evaluation of male sexual function in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) treated with a phytotherapeutic agent (Permixon ), tamsulosin or finasteride. Eur Urol 2005 48 269-76. 

Lose G, Englev E. Oestradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. BJOG 2000 107(8) 1029-34. 

Gerber GS, Fitzpatrick JM. The role of a lipido-sterolic extract of Serenoa repens in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU lnt. 2004 94 338-344. 

Symptomatic benign prostatic hyperplasia (BPH) is a common medical problem in older men. As many as 40% of men aged 60 years or older have lower urinary tract symptoms consistent with bladder outlet obstruction. Treatment goals in the vast majority of men are to relieve bothersome symptoms that reduce quality of life. In the U.S., treatment for benign prostatic hyperplasia costs more than 2 billion per year and accounts for 1.7 million physician office visits annually (Ishani et al., 2000). 

The management of lower urinary tract symptoms suggestive of clinical symptomatic BPH remains somewhat controversial. Treatment options range from watchful waiting, for those patients wishing to delay any active therapy, to minimally invasive treatment, such as transurethral needle ablation of the prostate and transurethral microwave therapy, to surgical interventions in the form of transurethral prostatectomy or open enucleation of the prostate. Most patients present with difficulties in urination for which a variety of medical therapies are available, including synthetic 5-a-reductase inhibitors, a-blockers, and plant extracts (Boyle et al., 2000). 

To assess the effects of Permixon in men with lower urinary tract symptoms and BPH, a meta analysis of all available clinical trial data was undertaken. Boyle et al. (2000), in randomized clinical trials involving 2859 patients, found that Permixon in the treatment of men with BPH revealed a significant improvement in peak flow rate and reduction in nocturia. 

The role of obesity in ED has been confirmed in large-scale, cross-sectional, and longitudinal studies (53,54). In a study in The Netherlands, 1700 Dutch men between the age of 50 and 75 were evaluated for the presence of ED and other health conditions (55). Body mass index (BMI) was found to be a significant predictor of ED, both as a single factor and in combination with other risk factors (e.g., lower urinary tract symptoms (LUTS), hypertension, diabetes). 

Sanchez-Chapado M, Guil M, Alfaro V, Badiella L, Fernandez-Hernando N. Safety and efficacy of sustained-release alfuzosin on lower urinary tract symptoms snggestive of benign prostatic hyperplasia in 3,095 Spanish patients evaluated during general practice. Eur Urol 2000 37(4) 421-7. 

S. repens (American dwarf palm tree, cabbage palm, sabal, saw palmetto) has mainly been used to treat benign prostatic hyperplasia. In placebo-controlled and comparative studies its efficacy in benign prostatic hyperplasia and lower urinary tract symptoms has been demonstrated (5). Numerous mechanisms of action have been proposed, including an antiandrogenic action, an anti-inflammatory effect, and an antiproliferative influence through inhibition of growth factors. 

Michel MC, Mehlburger L, Bressel H-U, Schumacher H, Schafers RF, Goepel M. Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms does comorbidity alter tolerability J Urol 1998 160 784-791. 

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