Is a very common disease in the adult men, affecting usually men after 40, strongly influencing a quality of life and also causing a significant economic burden on micro – family and macro – society scale. Its progressive form can lead to the AUR (acute urinary retention) – with the other words retention of the urine to the kidneys, which may lead even to injury of the kidneys. For this and also considering quality of life (QoL) reason, it is extremely important to treat is as soon as possible.

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Risk Factors

• metabolic disorder 

• due to the multifactorial nature of the LUTS (same symptoms might be caused by very different factors), risk factors for LUTS might be the same as for other urological conditions as cigarette smoking, genetics, low liquid intake, diet, psychological factors…

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Symptoms

 

• painful bladder

• inability to pass the urine

• reduced urine flow

• increased detrusor pressure or involuntary contractions

• overactive bladder – urinary urgency

• increased urinary frequency

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possible causes for the symptoms mentioned above might be very different, that is why doctor will propose a detailed examination to determine the real cause. Below some of the possible conditions of the above symptoms:

 

• ureteric stone

• urethral stricture

• foreign body

• urinary tract infection

• bladder tumor

• neurogenic bladder disfunction

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Diagnostic

 

• medical history – to identify potential causes

• current lifestyle habits, medications including emotional and psychological factors

• voiding diary – to understand the dynamics of the condition, doctor might ask patient to fill some questionnairesor deliver a diary- please see the section “How to prepare for the visit”. The diagnosis might be faster and easier if patient will come for the visit with certain data observed

• physical examination

• DRE – digital rectal exam(to predict prostate size)

• TRUS – transrectal ultrasound

• urine analysis (to exclude urinary tract infections, hematuria, to evaluate renal function)

• PSA test

• kidney function test (urine + blood)

• PVR – post void residual urine – to check if bladder is functioning properly

• urodynamics – to evaluate bladder neuro functioning more specific

 

 

Treatment options

 

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Pharmacological treatment

 

a1 blockers

considered first line drug treatment for the urinary symptoms and flow rate. Need to be taken long time to achieve the effect. 

 

disadvantages

• do not help with urodynamically determined bladder outlet resistance, with other words in cases, when bladder disfunction is caused by neurological issues

• does not effect prostate size, does not prevent acute urinary retention (AUR)

• long time therapy – at least 4 years 

• may cause asthenia (physical and psychological weakness of the body - weight loos, muscle decrease, etc)

• dizziness

• hypotension

• affect cataract surgery (ophthalmologist should be informed!)

• cause decrease of absence of seminal fluid (ejaculatory disfunction - EjD)

• does not prevent need of surgery

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advantages

• reduce urinary symptoms by 30 – 40% and improves flow rate by 20 – 25% 

• can reduce storage and voiding symptoms

• has small beneficial effect on erectile function

 

 

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5a reductase inhibitors

 

might be considered for the patients with moderate and severe urinary symptoms due to enlarged prostate

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disadvantages

• erectile disfunction

• reduced libido

• EjD ejaculation disfunction or failure

• gynecomastia

• higher incidence in high grade cancer (according to two studies)

• cardiovascular side effects – according to some studies, and non - according to other

• long time treatment required 6-12 month for the initial results, 2 – 4 years to achieve the result

 

 

advantages

• decrease of the urinary symptoms by 15-30% after 2-4 years treatment

• decrease of prostatic volume by 18-28% after 2-4 years of treatment

• reduce of 1 year risk of acute urinary retention or need for surgery by according to different studies about 57% and accordingly 34%

• can prevent disease progression

 

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Surgical treatments – TURP (transurethral resection of the prostate),

minimally invasive Prostatectomy lap or robot.

 

recommended for the patients with:

• urinary retention (also recurrent and refractory)

• overflow incontinence

• bladder stones

• bladder diverticula

• recurrent urinary tract infections UTI

• haematuria – blood in the urine

• dilatation of the upper urinary tract

• renal isufficiency

• pharmacological treatments do not work

• other surgical procedures as lap or robot simple prostatectomy, laser enucleation with are specific for each case.

 

disadvantages

 

• surgical and anesthetic risks – ask your surgeon about his and general complication rates

• requires a very experienced surgeon

 

advantages

• substantial flow improvement (+162%)

• significant reduction of urinary symptoms (-70%)

• durable (long term) outcomes

• longest study confirmed outcomes 8-22 years

• improves urodynamic parameters

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