Database: Ovid MEDLINE(R) <2006 to March Week 3 2010>
Search Strategy:
-------------------------------------------------------------------------------1 lower urinary tract symptoms.mp. (1110)
2 lower urinary tract symptoms.ti. (436)
3 limit 2 to (english language and "review articles" and humans) (76)
4 limit 3 to full text (55)
5 limit 4 to yr=2008-current (28)
6 from 5 keep 1-28 (28)
***************************
<1>
Unique Identifier
19846144
Status
MEDLINE
Authors
Sarma AV. Parsons JK. McVary K. Wei JT.
Authors Full Name
Sarma, Aruna V. Parsons, J Kellogg. McVary, Kevin. Wei, John T.
Institution
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
asarma@umich.edu
Title
Diabetes and benign prostatic hyperplasia/lower urinary tract symptoms--what do we know?.
[Review] [31 refs]
Source
Journal of Urology. 182(6 Suppl):S32-7, 2009 Dec.
Abstract
PURPOSE: Benign prostatic hyperplasia and associated lower urinary tract symptoms are
highly prevalent in older men and represent a substantial challenge to public health. Apart from
the prevalence of benign prostatic hyperplasia increasing with age, little is understood regarding
its etiology and natural history. Increasing evidence recently pointed toward relationships
between diabetes and benign prostatic hyperplasia/lower urinary tract symptoms. We present an
overview of the current understanding of clinical and epidemiological research on diabetes and
benign prostatic hyperplasia/lower urinary tract symptoms, the hypothesized pathophysiological
mechanisms linking the conditions and recommendations for future directions for research.
MATERIALS AND METHODS: A structured, comprehensive literature review was done to
identify studies of the relationships between benign prostatic hyperplasia and lower urinary tract
symptoms, and diabetes in older men. RESULTS: A substantial proportion of the existing body
of literature supports an association between diabetes and benign prostatic hyperplasia/lower
urinary tract symptoms. However, failure to differentiate lower urinary tract symptoms from
benign prostatic hyperplasia contributed to some of the confusing evidence in studies including
more specific benign prostatic hyperplasia measurements. This could be due in part to the largely
cross-sectional analyses, the use of select or different study populations, limited sample sizes and
inadequate control of potential confounders. CONCLUSIONS: Diabetes may substantially
influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms in older
men. Further prospective, longitudinal analyses of the impact of diabetes and its etiological
mechanisms on benign prostatic hyperplasia/lower urinary tract symptoms may identify novel
interventions to prevent, diagnose and treat these highly prevalent conditions. [References: 31]
Publication Type
Journal Article. Review.
<2>
Unique Identifier
19942050
Status
MEDLINE
Authors
Le BV. Schaeffer AJ.
Authors Full Name
Le, Brian V. Schaeffer, Anthony J.
Institution
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL,
USA.
Title
Genitourinary pain syndromes, prostatitis, and lower urinary tract symptoms. [Review] [58
refs]
Source
Urologic Clinics of North America. 36(4):527-36, vii, 2009 Nov.
Abstract
The overlap of pain and urinary voiding symptoms is common for urologic patients. The
etiology of these syndromes is frequently multifactorial and due to disorders of the bladder
and/or prostate. The evaluation and treatment of these syndromes continues to evolve. Here we
summarize the general approach to evaluation and treatment of these pain syndromes.
[References: 58]
Publication Type
Journal Article. Research Support, N.I.H., Extramural. Review.
<3>
Unique Identifier
19942048
Status
MEDLINE
Authors
Donnell RF.
Authors Full Name
Donnell, Robert F.
Institution
The Department of Urology, The Medical College of Wisconsin, 9200 W. Wisconsin Avenue,
Milwaukee, WI 53226, USA. rdonnell@mcw.edu
Title
Minimally invasive therapy of lower urinary tract symptoms. [Review] [96 refs]
Source
Urologic Clinics of North America. 36(4):497-509, vi-vii, 2009 Nov.
Abstract
The establishment of guidelines, pharmacologic therapies, improved understanding of lower
urinary tract symptoms (LUTS) versus benign prostate hyperplasia (BPH), respect for patientcentered goals, and improved discrimination of the patient with occult prostate cancer have
empowered change in the management of LUTS. These developments have allowed urologists to
recognize the limitations of transurethral prostatectomy as the gold standard and search for
"ideal therapies" to provide treatments with an improved relief of symptoms, decreased
complication rate and cost, to correct BPH-associated morbidities and prevent future
morbidities. Prognostic parameters and their ability to predict progression may be important in
the future of LUTS management and selection of therapy. [References: 96]
Publication Type
Journal Article. Review.
<4>
Unique Identifier
19942043
Status
MEDLINE
Authors
Mehdizadeh JL. Leach GE.
Authors Full Name
Mehdizadeh, Jennifer L. Leach, Gary E.
Institution
Tower Urology, CA, USA.
Title
Role of invasive urodynamic testing in benign prostatic hyperplasia and male lower urinary
tract symptoms. [Review] [56 refs]
Source
Urologic Clinics of North America. 36(4):431-41, v, 2009 Nov.
Abstract
The role of urodynamics in the evaluation of lower urinary tract symptoms in men with benign
prostatic hyperplasia is controversial despite the additional information regarding bladder
function and outlet obstruction it provides. This controversy is primarily based on outcome
studies that suggest men without proved bladder outlet obstruction may benefit from outlet
reduction with medication or surgical resection. The aim of this article is to describe the role of
urodynamic studies in the evaluation of benign prostatic hyperplasia, including illustration of
existing urodynamic techniques, reviewing best practice guidelines and current literature, and
providing recommendations for use of urodynamics in clinical practice. [References: 56]
Publication Type
Journal Article. Review.
<5>
Unique Identifier
19239452
Status
MEDLINE
Authors
Roumeguere T. Zouaoui Boudjeltia K. Hauzeur C. Schulman C. Vanhaeverbeek M. Wespes
E.
Authors Full Name
Roumeguere, Thierry. Zouaoui Boudjeltia, K. Hauzeur, Claude. Schulman, Claude.
Vanhaeverbeek, Michel. Wespes, Eric.
Institution
Laboratory of Experimental Medicine, CHU Charleroi, ULB, Montigny -le -Tilleul, Belgium.
thierry.roumeguere@ulb.ac.be
Title
Is there a rationale for the chronic use of phosphodiesterase-5 inhibitors for lower urinary tract
symptoms secondary to benign prostatic hyperplasia?. [Review] [67 refs]
Source
BJU International. 104(4):511-7, 2009 Aug.
Abstract
OBJECTIVES: To critically review the physiological roles of phosphodiesterase-5 (PDE5), to
explain and support the putative impact and clinical significance of PDE5 inhibitors (PDE5-Is) in
the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic
hyperplasia (BPH) and erectile dysfunction (ED), both highly prevalent in men aged > or =50
years, as PDE5-Is are very effective as a first-line therapy for ED, and attractive for further
physiological functional investigations. METHODS: We searched Medline for peer-reviewed
articles in English, from 1991 to 2008, to provide a critical contemporary review of PDE5
pertaining to the potential interest of findings supporting a role for PDE5-Is in LUTS due to
BPH. The selection of papers was based on the relevance of subject matter. A critical analysis of
available fundamental and clinical data is reported. RESULTS: Several studies assessed the role
of the nitric oxide/cGMP signalling pathway in the regulation of the prostate tone, with the
support of clinical observations. PDE5-Is can also represent a potential mode of action allowing
the targeting of transcriptional activity implicated in the regulation of the progression of the
inflammatory process involved in BPH. PDE5-Is can inhibit human stromal cell proliferation of
the prostate mediated by cGMP accumulation. New targeting hypotheses of pathophysiological
processes are also reported. CONCLUSIONS: There is evidence that LUTS and ED are strongly
linked. This analysis of the regulatory basis of PDE5 biology could indicate several directions of
investigation. However, it is necessary to devise well-designed large prospective studies that
would produce significant data before this approach becomes a standard of care. [References:
67]
Publication Type
Journal Article. Review.
<6>
Unique Identifier
19570484
Status
MEDLINE
Authors
Mongiu AK. McVary KT.
Authors Full Name
Mongiu, Anne K. McVary, Kevin T.
Institution
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
60611, USA. k-mcvary@northwestern.edu
Title
Lower urinary tract symptoms, benign prostatic hyperplasia, and obesity. [Review] [51 refs]
Source
Current Urology Reports. 10(4):247-53, 2009 Jul.
Abstract
Obesity has emerged as a global public health challenge. During the past 20 years, there has
been a dramatic increase in obesity in the United States. In 2007, only one state had a prevalence
of obesity less than 20%. In this growing epidemic of national concern is an emerging
relationship between lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH),
and obesity. BPH is the most common neoplastic condition afflicting men and constitutes a major
factor impacting the health of the American male. Associations among obesity, physical
inactivity, and BPH/LUTS resulting from epidemiological studies have not been explored via
clinical trial methodology. A review of the available data appears to support a strong
independent relationship between obesity and BPH/LUTS. This review also indicates that gene
expression within the prostate varies with prostate size and can be affected by lifestyle
modifications. Future studies may lead to office detection of a patient's particular
polymorphisms, which may help guide individual treatment and lifestyle modifications that are
more likely to succeed. [References: 51]
Publication Type
Journal Article. Review.
<7>
Unique Identifier
19444118
Status
MEDLINE
Authors
Milsom I.
Authors Full Name
Milsom, Ian.
Institution
Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University,
Sahlgrenska University Hospital, Gothenburg, Sweden. ian.milsom@gu.se
Title
Lower urinary tract symptoms in women. [Review] [43 refs]
Source
Current Opinion in Urology. 19(4):337-41, 2009 Jul.
Abstract
PURPOSE OF REVIEW: To summarize recent population-based literature on the prevalence
and consequences of urinary incontinence and overactive bladder (OAB) symptoms in women
and describe our present knowledge regarding known risk factors. RECENT FINDINGS: The
prevalence of urinary incontinence in women ranged from 5 to 69%, with most studies reporting
a prevalence of any urinary incontinence in the range of 25-45%. In a longitudinal population
study in which women were followed for 16 years, the overall prevalence of urinary incontinence
increased from 15 to 28%, and the incidence rate of urinary incontinence was 21%, whereas the
corresponding remission rate was 34%. Increasing evidence is now available regarding a genetic
component in the cause of stress urinary incontinence. The reported prevalence of OAB in
women varied between 7.7 and 31.3%, and in general, prevalence rates increased with age. In a
longitudinal study, the prevalence of OAB, nocturia and daytime micturition frequency of eight
or more times per day increased by 9, 20 and 3%, respectively, in a cohort of women followed
from 1991 to 2007. The incidence of OAB was 20%, and the corresponding remission rate was
43%. SUMMARY: Urinary incontinence and OAB are highly prevalent conditions. The cost of
illness for urinary incontinence and OAB is a substantial economic and human burden and is
likely to increase further in the future, highlighting the need for effective forms of management.
[References: 43]
Publication Type
Journal Article. Review.
<8>
Unique Identifier
19057216
Status
MEDLINE
Authors
Gravas S. Melekos MD.
Authors Full Name
Gravas, Stavros. Melekos, Michael D.
Institution
Department of Urology, University Hospital of Larissa, Larissa, Greece.
sgravas2002@yahoo.com
Title
Male lower urinary tract symptoms: how do symptoms guide our choice of treatment?.
[Review] [32 refs]
Source
Current Opinion in Urology. 19(1):49-54, 2009 Jan.
Abstract
PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) include voiding, storage, and
postmicturition symptoms whereas in addition LUTS and sexual dysfunction are highly
prevalent in aging men. The present article investigates how symptoms can guide our initial
therapeutic approach to male LUTS and provides the recent data on the current treatment
options. RECENT FINDINGS: Recent studies suggest that not all male LUTS are associated with
prostate pathology and that bladder plays a role in the development of LUTS and especially in
storage symptoms. In addition to the traditional drug classes including alpha-blockers and
5alpha-reductase inhibitors, there is an increasing flow of data on the use of anticholinergics and
phosphodiesterase type 5 inhibitors. Available studies provide high-level evidence on the efficacy
and safety of these medical treatments. The upcoming data are beginning to shape new strategies
for the initial management of male LUTS. SUMMARY: Male LUTS have a complex nature and
there is an overlap of storage and voiding symptoms. Weighing of storage versus voiding
symptoms is a decisive factor for the selection of medical treatment. In addition, assessment of
specific voiding and prostate parameters and the status of patient's sexual function may guide
our choice. [References: 32]
Publication Type
Journal Article. Review.
<9>
Unique Identifier
19057212
Status
MEDLINE
Authors
Ilie CP. Chancellor MB.
Authors Full Name
Ilie, Cristian P. Chancellor, Michael B.
Institution
Central Clinical Emergency Military Hospital, Urology Department, Bucharest, Romania.
Title
Perspective of Botox for treatment of male lower urinary tract symptoms. [Review] [52 refs]
Source
Current Opinion in Urology. 19(1):20-5, 2009 Jan.
Abstract
PURPOSE OF REVIEW: Lower urinary tract symptoms suggestive of benign prostatic
hyperplasia (BPH) are frequently encountered in ageing men. The medical treatment for lower
urinary tract symptoms/BPH is not totally effective or without side effects. The use of
transurethral resection of the prostate, the 'gold standard' surgical intervention for BPH is
progressively changing to minimally invasive surgical therapies. But none of them provided clear
long-term results, with no complication. Thus, there has been much interest in the development
of alternative treatments such as the injection of botulinum toxin type A (BTX-A) into the
prostate. RECENT FINDINGS: There are two main factors that contribute to lower urinary
tract symptoms in BPH: the excessive growth (static component) and increase in smooth muscle
tone (dynamic component). BTX-A seems to be the first therapeutic agent to target both factors.
Its use inhibits the autonomic efferent effects on prostate growth and contraction and also
inhibits the abnormal afferent effects on prostate sensation. BTX-A injected into prostate
appears to be well tolerated and effective. SUMMARY: Although the clinical series demonstrate
efficacy of minimum 6 months, more studies are necessary in order to identify the mechanisms
by which BTX-A affects the prostate, the ideal dose and the duration of effect. BTX-A use in
prostate disease is currently 'off-label'. [References: 52]
Publication Type
Journal Article. Review.
<10>
Unique Identifier
19089674
Status
MEDLINE
Authors
Di Benedetto P. Delneri C. Biasutti E. Bragadin LM. Giorgini T.
Authors Full Name
Di Benedetto, Paolo. Delneri, Cristina. Biasutti, Emanuele. Bragadin, Luisa Monti. Giorgini,
Tullio.
Institution
paolo.dibenedetto@ass4.sanita.fvg.it
Title
Vesicourethral dysfunction in multiple sclerosis. Initial assessment based on lower urinary tract
symptoms and their pathophysiology. [Review] [17 refs]
Source
Neurological Sciences. 29 Suppl 4:S348-51, 2008 Dec.
Abstract
The most common lower urinary tract symptoms (LUTS) in multiple sclerosis (MS) are
irritative, obstructive or mixed (association of irritative and obstructive LUTS). Generally
irritative LUTS are typical in patients with cortical, brainstem or mild spinal cord lesions;
obstructive symptoms are frequent in patients with spinal cord lesions (below the pontine
micturition centre) or at the level of the sacral micturition centre. Irritative LUTS are often
associated with detrusor overactivity, whereas obstructive LUTS are associated with detrusor
sphincter dyssynergia or detrusor areflexia/hypocontractility. Proper management of these
LUTS often could be planned without specialised assessment, in accordance with the algorithms
proposed by International Consultation on Incontinence. [References: 17]
Publication Type
Journal Article. Review.
<11>
Unique Identifier
19032606
Status
MEDLINE
Authors
Roehrborn CG.
Authors Full Name
Roehrborn, Claus G.
Institution
University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX 753909110, USA. claus.roehrborn@utsouthwestern.edu
Title
Currently available treatment guidelines for men with lower urinary tract symptoms. [Review]
[11 refs]
Source
BJU International. 102 Suppl 2:18-23, 2008 Nov.
Publication Type
Journal Article. Review.
<12>
Unique Identifier
19032605
Status
MEDLINE
Authors
Roehrborn CG.
Authors Full Name
Roehrborn, Claus G.
Institution
University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX 753909110, USA. claus.roehrborn@utsouthwestern.edu
Title
Clinical management of lower urinary tract symptoms with combined medical therapy.
[Review] [37 refs]
Source
BJU International. 102 Suppl 2:13-7, 2008 Nov.
Publication Type
Journal Article. Review.
<13>
Unique Identifier
18607596
Status
MEDLINE
Authors
Kedia GT. Uckert S. Jonas U. Kuczyk MA. Burchardt M.
Authors Full Name
Kedia, George T. Uckert, Stefan. Jonas, Udo. Kuczyk, Markus A. Burchardt, Martin.
Institution
Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover,
Germany. kedia.george@mh-hannover.de
Title
The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary
tract symptoms. [Review] [52 refs]
Source
World Journal of Urology. 26(6):603-9, 2008 Dec.
Abstract
To date, there is an increasing interest in the nitric oxide (NO) pathway as a potential
pharmacological target to treat male lower urinary tract symptomatology (LUTS). In the
transition zone of the human prostate, a dense nitrinergic innervation has been shown of the
fibromuscular stroma, glandular epithelium and blood vessels. The expression of key proteins of
the NO pathway, such as the endothelial and neuronal nitric oxide synthase (eNOS, nNOS),
cGMP-degrading phosphodiesterase type 5 (PDE5) and cGMP-binding protein kinase (cGK), has
also been demonstrated. The hypothesis that an impaired NO/cGMP-signaling may contribute to
the pathophysiology of benign prostatic hyperplasia (BPH) is supported by the results from
randomized, placebo-controlled clinical studies, indicating that NO donor drugs and PDE5inhibitors sildenafil, tadalafil and vardenafil may be useful to treat storage and voiding
dysfunctions resulting from LUTS in men. Thus, given a potential role of the NO-pathway in the
prostate and/or in other parts of lower urinary tract (e.g. bladder), the enhancement of the NO
signaling by NO donor drugs, PDE5 inhibitors or activators of the soluble guanylyl cyclase (sGC)
may represent a new therapeutic strategy for the treatment of LUTS. This review serves to focus
on the role of NO and the NO-dependent signaling in the control of smooth muscle function in the
human prostate. Results from clinical trials in men with LUTS/BPH are also discussed.
[References: 52]
Publication Type
Journal Article. Review.
<14>
Unique Identifier
18571306
Status
MEDLINE
Authors
Oeconomou A. Madersbacher H. Kiss G. Berger TJ. Melekos M. Rehder P.
Authors Full Name
Oeconomou, Athanassios. Madersbacher, Helmut. Kiss, Gustav. Berger, Thomas J. Melekos,
Michael. Rehder, Peter.
Institution
Department of Urology, University of Thessalia School of Medicine, Larissa, Greece.
Title
Is botulinum neurotoxin type A (BoNT-A) a novel therapy for lower urinary tract symptoms
due to benign prostatic enlargement? A review of the literature. [Review] [40 refs]
Comments
Comment in: Eur Urol. 2008 Oct;54(4):775-6; PMID: 18571305], Comment in: Eur Urol. 2008
Oct;54(4):776-7; PMID: 18571304]
Source
European Urology. 54(4):765-75, 2008 Oct.
Abstract
CONTEXT: The intraprostatic injection of botulinum neurotoxin type A (BoNT-A) is a
minimally invasive but still-experimental treatment of lower urinary tract symptoms (LUTS) due
to benign prostatic enlargement (BPE) based on an off-label use of the drug. OBJECTIVE:
Report the mechanisms of action of BoNT-A on the prostate as well as the efficacy and safety of
intraprostatic BoNT-A injection according to various injection protocols. EVIDENCE
ACQUISITION: We searched the Medical Literature Analysis and Retrieval System Online
(MEDLINE) database and the abstract volumes of the 2005, 2006, and 2007 European
Association of Urology (EAU), American Urological Association (AUA) and International
Continence Society (ICS) meetings for studies on intraprostatic BoNT-A injection. EVIDENCE
SYNTHESIS: Five experimental studies and 10 clinical studies were found. The level of evidence
is 1b for one study and 3 for the other studies, with grades of recommendation of A and C,
respectively. The experimental studies report induced relaxation of the prostate, atrophy, and
reduction of its size through inhibition of the trophic effect of the autonomic system on the
prostate gland. In the clinical studies, all patients had LUTS due to BPE and prostate volume
varied from <20 ml to >80 ml. The dose varied from 100U to 300U of Botox((R)). The injection
was performed transperineally, transrectally, or transurethrally under general, local, or without
anesthesia. The follow-up period ranged from 3 mo to 19.8 mo. All studies reported an
improvement of maximum urinary flow rate, quality-of-life index and reduction of International
Prostate Symptoms Score, prostate-specific antigen (PSA) level, post-void residual volume, and
prostate volume. Local or systemic side effects were rare. Only patients with retention needed a
urethral drainage catheter. CONCLUSIONS: BoNT-A intraprostatic injection provides
improvement in patients with LUTS due to BPE refractory to medical treatment. However, there
is a need for large placebo controlled-studies and long-term results. So far the therapy is still
experimental. [References: 40]
Publication Type
Journal Article. Review.
<15>
Unique Identifier
18765128
Status
MEDLINE
Authors
Clarke JC. Clarke H Jr.
Authors Full Name
Clarke, Joseph C. Clarke, Harry Jr.
Institution
Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB
644, PO Box 250620, Charleston, SC 29425, USA.
Title
Combination 5-alpha-reductase inhibitors and alpha-blockers for treatment of lower urinary
tract symptoms secondary to benign prostatic hyperplasia. [Review] [11 refs]
Source
Current Urology Reports. 9(4):291-4, 2008 Jul.
Abstract
Open or transurethral resection of the prostate was once the only option for men afflicted with
symptomatic benign prostatic hyperplasia (BPH). In the past 10 to 15 years, however, medical
management has become a common step in the treatment of BPH, often postponing or
eliminating the need for surgical intervention. The two drug classes used in the medical
management of BPH are alpha-blockers and 5-alpha-reductase inhibitors. This paper reviews
major studies related to the use of these medications in combination and discusses patient
populations best served by combination therapy. [References: 11]
Publication Type
Journal Article. Review.
<16>
Unique Identifier
18594831
Status
MEDLINE
Authors
Yassin AA. El-Sakka AI. Saad F. Gooren LJ.
Authors Full Name
Yassin, Aksam A. El-Sakka, Ahmed I. Saad, Farid. Gooren, Louis J G.
Institution
Institute of Urology and Andrology, Segeberger Kliniken, Norderstedt, Germany. yassin@tonline.de
Title
Lower urinary-tract symptoms and testosterone in elderly men. [Review] [55 refs]
Source
World Journal of Urology. 26(4):359-64, 2008 Aug.
Other ID
Source: NLM. PMC2517082
Abstract
OBJECTIVES: The objective was to examine the effects of testosterone administration on
symptom scores of lower urinary tract symptoms (LUTS). METHODS: The literatures on the
epidemiological association between the metabolic syndrome, erectile failure and (LUTS) were
reviewed. RESULTS: In men with the metabolic syndrome and erectile failure, often lower-thannormal testosterone levels are found. This is less clear for men with LUTS, but the relationship
between testosterone and LUTS might be indirect and based on the association of the metabolic
syndrome with an overactivity of autonomic nervous system. This overactivity may play a key
role in increasing the severity of LUTS above an intrinsic basal intensity that is determined by
the genitourinary factors in aging men. Androgen receptors are present in the epithelium of the
urethra and the bladder. Testosterone may play a role in the reflex activity of the autonomic
nervous system in the pelvis, or may interact with postsynaptic non-genomic receptors
suppressing detrusor activity. Human neurons in the wall of the bladder contain nitric oxide
synthase. Similar to the penis, testosterone has an impact on nitric oxide synthase.
CONCLUSIONS: Some studies investigating the effects of normalizing testosterone levels in
elderly men have found a positive effect on variables of the metabolic syndrome and,
simultaneously, on scores of the International Prostate Symptoms Score (IPSS) which is worthy
of further investigation in randomized, controlled and sufficiently powered clinical trials.
[References: 55]
Publication Type
Journal Article. Review.
<17>
Unique Identifier
18423969
Status
MEDLINE
Authors
Chapple CR. Wein AJ. Abrams P. Dmochowski RR. Giuliano F. Kaplan SA. McVary KT.
Roehrborn CG.
Authors Full Name
Chapple, Christopher R. Wein, Alan J. Abrams, Paul. Dmochowski, Roger R. Giuliano,
Francois. Kaplan, Steven A. McVary, Kevin T. Roehrborn, Claus G.
Institution
The Royal Hallamshire Hospital, Sheffield, UK. c.r.chapple@sheffield.ac.uk
Title
Lower urinary tract symptoms revisited: a broader clinical perspective. [Review] [43 refs]
Source
European Urology. 54(3):563-9, 2008 Sep.
Abstract
CONTEXT: The term "lower urinary tract symptoms" (LUTS) was introduced to dissociate
male urinary symptoms from any implied site of symptom origin, such as the prostate.
OBJECTIVE: To consider a more expansive view of LUTS, moving beyond an organocentric
focus. EVIDENCE ACQUISITION: Review of the available literature by a consensus panel.
EVIDENCE SYNTHESIS: A consensus group reviewed the literature and developed a
conceptual framework to facilitate research and clinical practice in patients with LUTS,
following steps outlined in the Delphi procedure. Committee discussion, with presentations and
review of existing literature and knowledge at four separate occasions, and extensive review and
discussion of draft documents encapsulating group views followed. Consensus group findings
included evidence that LUTS increase with age and are prevalent in both male and female
patients, with differences in the prevalence of individual storage, voiding, and postmicturition
symptoms representing underlying pathophysiologic factors between the sexes. Additionally, it
was recognised that patients often have underlying and overlapping pathophysiologic
mechanisms that may be related to the expression of LUTS and that this global approach to
LUTS reflects our contemporary recognition of the lower urinary tract as an integrated
functional unit. To improve the current management of patients, education and awareness
regarding LUTS, its causes, and associated comorbidities are needed. Major limitations of this
work are the potential interpretive bias introduced by prior perceptions and the nature of the
study populations drawn conventionally from secondary care. CONCLUSIONS: In conclusion, it
is misleading to attribute individual symptoms to sex differences or to a specific underlying
organ. LUTS are a non-sex-specific, non-organ-specific group of symptoms, which are sometimes
age-related and progressive. A need exists to increase education and awareness regarding LUTS,
its causes, and associated comorbidities, and to assess and treat men and women for all LUTS,
not just selected symptoms. [References: 43]
Publication Type
Journal Article. Research Support, Non-U.S. Gov't. Review.
<18>
Unique Identifier
18675613
Status
MEDLINE
Authors
Colon I. Payne RE.
Authors Full Name
Colon, Ivan. Payne, Richard E.
Institution
Department of Urology, Downstate Medical Center, Brooklyn, NY 11203, USA.
Ivan.colon@downstate.edu
Title
Benign prostatic hyperplasia and lower urinary tract symptoms in African Americans and
Latinos: treatment in the context of common comorbidities. [Review] [68 refs]
Source
American Journal of Medicine. 121(8 Suppl 2):S18-26, 2008 Aug.
Abstract
Benign prostatic hyperplasia (BPH), with accompanying lower urinary tract symptoms (LUTS),
is a common age-related condition associated with a variety of cardiovascular, metabolic, and
sexual comorbidities. While there is debate, in the United States race and ethnicity, particularly
among Latinos and African American men, may confer an elevated risk for BPH and LUTS.
Hypertension and deficits in sexual health are more common among African American men,
while both Latino and African American men experience more metabolic-related disorders,
including diabetes mellitus, insulin resistance, and end-stage renal disease. Although
socioeconomic factors may play a significant role in these disparities, pathological and genetic
variations between patients of different races and ethnicities are additional factors in the
development of BPH. The proliferation of available treatments for BPH demands greater
discernment in treatment selection, and comorbidities represent a central criterion upon which
choice of appropriate BPH therapy should be based. This article reviews common comorbidities
in minority populations, describes challenges to BPH management, and discusses medical,
surgical, and phytotherapeutic treatment options. [References: 68]
Publication Type
Journal Article. Review.
<19>
Unique Identifier
18041770
Status
MEDLINE
Authors
Hill SR. Fayyad AM. Jones GR.
Authors Full Name
Hill, Simon R. Fayyad, Abdalla M. Jones, Geraint R.
Institution
Royal Blackburn Hospital, Blackburn, UK. simon.hill@elht.nhs.uk
Title
Diabetes mellitus and female lower urinary tract symptoms: a review. [Review] [60 refs]
Source
Neurourology & Urodynamics. 27(5):362-7, 2008.
Abstract
Diabetes mellitus (DM) has reached epidemic proportions world wide. Many chronic
complications of DM, including neuropathy, retinopathy and nephropathy, have been well
studied and although urologic complications have been recognized since 1935, little is known
about DM as a pathophysiological risk factor for development of lower urinary tract symptoms
(LUTS) in women. Diabetic nephropathy, a life-threatening condition, has received considerable
attention in the last few years. Diabetic cystopathy, on the other hand, has received far less
attention despite having a significant impact on quality of life, and with significant individual
health risks. Initial studies suggested that long standing DM causes paralysis of the detrusor
muscle leading to voiding difficulties and this has been the received wisdom regarding diabetic
cystopathy for many years. In this review, we discuss what is currently known about lower
urinary tract function and urinary incontinence in diabetic females, with a critical analysis of the
available evidence and suggest areas for future research. [References: 60]
Publication Type
Journal Article. Review.
<20>
Unique Identifier
18423748
Status
MEDLINE
Authors
Dedhia RC. McVary KT.
Authors Full Name
Dedhia, Raj C. McVary, Kevin T.
Institution
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago,
Illinois 60611, USA.
Title
Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia.
[Review] [36 refs]
Source
Journal of Urology. 179(6):2119-25, 2008 Jun.
Abstract
PURPOSE: We examined the available data from clinical trials for certain botanicals used for
lower urinary tract symptoms secondary to benign prostatic hyperplasia, including Serenoa
repens (saw palmetto), Pygeum africanum (African plum), Secale cereale (rye pollen) and
Hypoxis rooperi (South African star grass). MATERIALS AND METHODS: MEDLINE and
The Cochrane Library searches were done in June 2007 using the terms benign prostatic
hyperplasia, lower urinary tract symptoms, phytotherapy, saw palmetto, Serenoa, Permixon,
Pygeum africanum, Tadenan, Cernilton, Cernitin and Hypoxis. Search results were assessed for
relevance and the inclusion of placebo controlled trials. RESULTS: Two systematic reviews and
3 clinical trials were examined in the evaluation of Serenoa repens. Data from the systematic
reviews showed an improvement in flow rates and symptoms. The results of 1 clinical trial were
equivocal and the remaining 2 trials clearly showed equivalence to placebo. Systematic reviews
were used in the evaluation of P. africanum, Secale cereale and Hypoxis rooperi. P. africanum
and H. rooperi showed an improvement in flow rates and symptoms compared to placebo, while
S. cereale showed an improvement in symptoms but not flow rates compared to placebo.
CONCLUSIONS: Most clinical trials of investigating the efficacy of botanicals suffer from well
documented methodological flaws. Saw palmetto has been clearly shown as comparable to
placebo in a trial of sound methodology. While preliminary results appear promising, to our
knowledge the remaining botanicals have yet to be evaluated in a trial of similar quality.
[References: 36]
Publication Type
Journal Article. Review.
<21>
Unique Identifier
18358592
Status
MEDLINE
Authors
Parsons JK. Kashefi C.
Authors Full Name
Parsons, J Kellogg. Kashefi, Carol.
Institution
Division of Urology, Department of Surgery, University of California, San Diego School of
Medicine, La Jolla, CA 92103-8897, USA. leparker@ucsd.edu <leparker@ucsd.edu>
Title
Physical activity, benign prostatic hyperplasia, and lower urinary tract symptoms. [Review] [30
refs]
Source
European Urology. 53(6):1228-35, 2008 Jun.
Abstract
BACKGROUND: While some studies have indicated that physical activity may protect against
benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), others have not.
OBJECTIVE: To evaluate the association of physical activity with BPH and LUTS. DESIGN,
SETTING, AND PARTICIPANTS: Systematic review and meta-analysis using MEDLINE, the
Cochrane Library, EMBASE, and abstracts from the Annual Meeting of the American
Urological Association. We selected observational studies that provided empirical data and
analyzed abstracted data with random effects models. MEASUREMENTS: BPH, LUTS, and
physical activity levels. RESULTS AND LIMITATIONS: Eleven (n=43 083 men) studies met
selection criteria. Eight studies observed inverse, 2 studies null, and 1 study equivocal
associations of physical activity with BPH or LUTS. Eight studies (n=35675) were eligible for
pooled analyses. We stratified physical activity levels into light, moderate, and vigorous
categories, with a sedentary category for reference. Compared to the sedentary group, the pooled
odds ratios for BPH or LUTS were 0.70 (95% CI 0.44-1.13, p=0.14), 0.74 (95% CI 0.60-0.92,
p=0.005), and 0.74 (95% CI 0.59-0.92, p=0.006) for men engaging in light, moderate, and heavy
physical activity, respectively. CONCLUSIONS: Physical activity reduces the risks of BPH and
LUTS. These findings are consistent with other studies demonstrating that the BPH/LUTS
complex is associated with modifiable risk factors of cardiovascular disease and suggest that
increased physical activity may prevent or attenuate these conditions. [References: 30]
Publication Type
Journal Article. Meta-Analysis. Review.
<22>
Unique Identifier
18075506
Status
MEDLINE
Authors
Pimentel H. Wald M. Niederberger C.
Authors Full Name
Pimentel, H. Wald, M. Niederberger, C.
Institution
Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA.
hpimente100@gmail.com
Title
Daily use of phosphodiesterase 5 inhibitors for erectile dysfunction and lower urinary tract
symptoms. [Review] [41 refs]
Source
International Journal of Impotence Research. 20(2):145-9, 2008 Mar-Apr.
Abstract
Erectile dysfunction is a prevalent disorder that not only affects men with the disorder but also
their partners. Significant improvements in the sexual health of these couples have been achieved
with the introduction of phosphodiesterase 5 (PDE5) inhibitors. Currently PDE5 inhibitors are
used on an on-demand basis. New evidence regarding the effects of PDE5 inhibitors on the
underlying pathophysiologic processes that cause erectile dysfunction have sparked interest in
the continuous dosing of these medications. We will discuss the biological background and the
available clinical evidence for the continuous use of phosphodiesterase inhibitors in erectile
dysfunction. Lastly, we will discuss the emerging clinical data for the use of daily PDE5 inhibitors
in men with lower urinary tract symptoms. [References: 41]
Publication Type
Journal Article. Review.
<23>
Unique Identifier
18307682
Status
MEDLINE
Authors
Giuliano F.
Authors Full Name
Giuliano, Francois.
Institution
Neuro-Uro-Andrology, Department of Physical Medicine and Rehabilitation, Raymond
Poincare Hospital, Garches, France. giuliano@cyber-sante.org
Title
Lower urinary tract symptoms and sexual dysfunction: a common approach. [Review] [31 refs]
Source
BJU International. 101 Suppl 3:22-6, 2008 Mar.
Abstract
Alpha(1)-adrenergic blockers (alpha(1)-blockers) are considered the most effective
monotherapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic
hyperplasia. Phosphodiesterase type-5 (PDE-5) inhibitors are the first-line treatment for erectile
dysfunction (ED). As LUTS and ED are strongly linked, co-prescription of both drug classes is
likely to increase. Interaction studies have confirmed that tadalafil, a long-acting PDE-5
inhibitor, has only marginal effects on blood pressure when co-administered with the selective
alpha(1)-blockers, alfuzosin or tamsulosin. alpha(1)-blockers show an incidence of ED similar to
placebo; they may even have some benefit on sexual function in men with concomitant LUTS and
sexual dysfunction, with the exception of tamsulosin which causes anejaculation. On the other
hand, PDE-5 inhibitors have a beneficial effect on LUTS. These agents are likely to act via
different mechanisms of action, providing the rationale for combining them to treat LUTS and
ED. Indeed, alfuzosin and tadalafil show an additive relaxant effect on human detrusor muscle,
human prostate tissue and human corpus cavernosum in vitro. A pilot study also suggests that
daily intake of alfuzosin 10 mg and sildenafil 25 mg is well tolerated and may be more effective
than monotherapy to improve LUTS and ED. Further research is warranted to establish the
value of this combination therapy in LUTS and ED. [References: 31]
Publication Type
Journal Article. Meta-Analysis. Review.
<24>
Unique Identifier
18304211
Status
MEDLINE
Authors
Schwinn DA. Roehrborn CG.
Authors Full Name
Schwinn, Debra A. Roehrborn, Claus G.
Institution
Department of Anesthesiology, University of Washington, Seattle, Washington 98195-6540,
USA. dschwinn@u.washington.edu
Title
Alpha1-adrenoceptor subtypes and lower urinary tract symptoms. [Review] [59 refs]
Source
International Journal of Urology. 15(3):193-9, 2008 Mar.
Other ID
Source: NLM. NIHMS41447
Source: NLM. PMC2329815
Abstract
Benign prostatic hyperplasia (BPH) is a common cause of urinary outflow obstruction in aging
men leading to lower urinary tract symptoms (LUTS). alpha(1)-Adrenoceptors (alpha(1)ARs)
antagonists (blockers) have become a mainstay of LUTS treatment because they relax prostate
smooth muscle and decrease urethral resistance, as well as relieving bladder LUTS symptoms. A
review of key recent clinical trials suggests new insights into the role of specific alpha(1)AR
subtypes in the treatment of LUTS. [References: 59]
Publication Type
Journal Article. Research Support, N.I.H., Extramural. Review.
<25>
Unique Identifier
18303512
Status
MEDLINE
Authors
Rickey LM. Kenton K.
Authors Full Name
Rickey, Leslie M. Kenton, Kimberly.
Institution
Division of Urology, Department of Surgery, University of Maryland Medical Center,
Baltimore, Maryland 21201, USA. lrickey@smail.umaryland.edu
Title
Botulinum toxin: new option for refractory lower urinary tract symptoms in women. [Review]
[48 refs]
Source
Clinical Obstetrics & Gynecology. 51(1):176-86, 2008 Mar.
Abstract
Lower urinary tract symptoms refractory to standard therapies create significant distress and
quality of life impact for women with these disorders. Likewise, they are challenging for
clinicians caring for these women. Once conservative measures are exhausted, the few remaining
treatment options are often invasive and associated with significant morbidity. Botulinum toxin is
an emerging medical therapy with increasing applications in the lower urinary tract and pelvic
floor, which has proven to be an effective and safe alternative for the treatment of some
refractory pelvic floor disorders. [References: 48]
Publication Type
Journal Article. Review.
<26>
Unique Identifier
18294115
Status
MEDLINE
Authors
Gallegos PJ. Frazee LA.
Authors Full Name
Gallegos, Patrick J. Frazee, Lawrence A.
Institution
Department of Pharmacy, Akron General Medical Center, Akron, Ohio, USA.
pgallego@neoucom.edu
Title
Anticholinergic therapy for lower urinary tract symptoms associated with benign prostatic
hyperplasia. [Review] [42 refs]
Source
Pharmacotherapy. 28(3):356-65, 2008 Mar.
Abstract
Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic
hyperplasia (BPH). The LUTS-BPH complex consists of both voiding and storage symptoms that
may overlap with overactive bladder symptoms. Drug therapy for men with LUTS may include
alpha1-antagonists, 5-alpha-reductase inhibitors, combination therapy, and over-the-counter
phytotherapy. Anticholinergic agents are effective in relieving overactive bladder symptoms in
patients without bladder outlet obstruction. However, anticholinergic therapy has historically
been contraindicated in patients with LUTS associated with BPH because of concerns for
developing acute urinary retention. To assess the safety and efficacy of anticholinergic therapies
for LUTS associated with BPH, a MEDLINE search and a bibliographic search of the Englishlanguage literature were conducted. Two nonrandomized, open-label studies; two randomized
trials that assessed anticholinergic therapy alone; and eight trials that assessed anticholinergic
therapy in combination with an alpha1-antagonist were identified. Trials were of short duration
(6-12 wks) and included only men with low postvoid residual volumes at baseline. Small
nonsignificant changes were seen in objective measures of urinary function. Several trials
demonstrated an increase in postvoid residual with anticholinergic therapy, which was
statistically significant in two trials. Despite the increase in postvoid residual, rates of acute
urinary retention were low and the drugs were well tolerated. Of the five trials that used a
validated symptom scoring scale, two demonstrated subjective improvement in urinary function.
Men with symptomatic overactive bladder and BPH who are not adequately relieved with
alpha1-antagonists may benefit from the addition of an anticholinergic agent. Before starting
therapy, however, a postvoid residual volume should be measured to measure to rule out baseline
urinary retention. [References: 42]
Publication Type
Journal Article. Review.
<27>
Unique Identifier
18197726
Status
MEDLINE
Authors
Gur S. Kadowitz PJ. Hellstrom WJ.
Authors Full Name
Gur, Serap. Kadowitz, Philip J. Hellstrom, Wayne J G.
Institution
Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana 70112, USA.
Title
Guide to drug therapy for lower urinary tract symptoms in patients with benign prostatic
obstruction : implications for sexual dysfunction. [Review] [134 refs]
Source
Drugs. 68(2):209-29, 2008.
Abstract
The relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS)
caused by benign prostatic obstruction (BPO) has recently gained increasing attention. Both BPO
and ED are highly prevalent in older men and both conditions frequently contribute to a
reduction in overall quality of life. Current medical treatment of LUTS/BPO consists of
monotherapy with alpha(1)-adrenoceptor antagonists or 5alpha-reductase inhibitors, a
combination of these two agents or, in some cases, various phytotherapeutic approaches. When
choosing a drug therapy, it is important to recognize that while 5alpha-reductase inhibitors
increase the risk of ED and ejaculatory disorders, and combined therapy carries the cumulative
risk of causing sexual dysfunction, some alpha(1)-adrenergic receptor antagonists have been
reported to improve overall sexual function. Therefore, the successful evaluation and
management of older men with LUTS associated with BPO should include an assessment of
baseline sexual function and subsequent monitoring of medication-induced sexual adverse effects.
In this review, we detail the pathophysiological mechanisms involved in LUTS/BPO-associated
ED, including reduced nitric oxide/cyclic guanosine monophosphate system activity, enhanced
endothelin-1/rhoA/rho kinase pathway activity, sympathetic overactivity, pelvic organ
atherosclerosis and potential preventive approaches. [References: 134]
Publication Type
Journal Article. Review.
<28>
Unique Identifier
18090483
Status
MEDLINE
Authors
Armitage J. Emberton M.
Authors Full Name
Armitage, James. Emberton, Mark.
Institution
Clinical Effectiveness Unit, The Royal College of Surgeons of England, University College,
London, UK.
Title
The role of anticholinergic drugs in men with lower urinary tract symptoms. [Review] [18 refs]
Source
Current Opinion in Urology. 18(1):11-5, 2008 Jan.
Abstract
PURPOSE OF REVIEW: Male lower urinary tract symptoms are often attributed to benign
prostatic hyperplasia. However, coexisting overactive bladder may be responsible for storage
symptoms in a substantial proportion. Treatment of these symptoms with anticholinergic drugs
has been considered hazardous in benign prostatic hyperplasia because of concerns that they
may predispose to acute urinary retention. We present recent research evidence on the
effectiveness and safety of anticholinergics for male lower urinary tract symptoms. RECENT
FINDINGS: Two systematic reviews and a large randomized controlled trial recently evaluated
anticholinergic drugs in men with lower urinary tract symptoms. These studies provided good
evidence that anticholinergics are effective at improving both urodynamic and patient-reported
outcomes. Postvoid residual urine volumes and urine flow rates were not significantly affected,
and acute urinary retention was rare. SUMMARY: In men with lower urinary tract symptoms
treatment may need to be directed at both the prostate and the bladder, and a pragmatic
approach therefore seems appropriate. Men presenting with lower urinary tract symptoms
should undergo comprehensive clinical evaluation before benign prostatic hyperplasia is treated,
if indicated. Should symptoms fail to resolve, addition of anticholinergic drugs may be considered
in the absence of significant postvoid residual urine volumes. [References: 18]
Publication Type
Journal Article. Research Support, Non-U.S. Gov't. Review.