OVERACTIVE BLADDER (OAB) TREATMENT IN MALE PATIENTS
Authors:
M. Záleský; R. Zachoval; V. Vik; P. Nencka
Authors‘ workplace:
Urologické oddělení Fakultní Thomayerovy nemocnice
Published in:
Urol List 2009; 7(2): 23-30
Overview
The co-occurrence of OAB (overactive bladder) and BPH (benign prostate hyperlasia) in male patients results in specific therapeutic approaches in OAB treatment and new perspectives on the treatment of lower urinary symptoms (LUTS). The objective of this article is to provide an overall summary of current information and possibilities of OAB treatment in male patients, notably in patients with concurrent incidence of OAB and BPH. The Medline database was searched for references including the following key words: male overactive bladder treatment. Information obtained via this source provided the basis for this article.
The overall prevalence of OAB in male patients according to epidemiological studies is 11-16 % and increases with age. It was demonstrated that most of the OAB symptoms in males are caused by detrusor hyperactivity, however only small proportion of these patients is treated with antimuscarinic agens. Males with OAB without concurrent BPH are in 56 % of cases inadequately treated with pharmacotherapy designated for the treatment of BPH.
The principal strategy of OAB treatment includes non-pharmacologic therapy supplemented with pharmacotherapy, represented mainly by antimuscarinic agens.
The safety of antimuscarinic therapy in patients with co-occurrence of OAB and BPH was demonstrated in several studies. Randomized controlled studies (RCTs) have shown the safety and effectiveness of antimuscarinic therapy in patients with OAB and BPH, notably in combination with alpha-blockers. The post urine residual increased in average by 23 ml, the mean frequency of urinary retention was 0,45 % without significant difference between patients treated with monotherapy, combination therapy or placebo. RCTs have shown that the combination of alpha-blockers and anticholinergic agens significantly improves OAB symptoms compared to monotherapy. Concerns regarding deterioration of bladder evacuation ability after antimuscarinic therapy in case of lower urinary system obstruction are common. Recent studies have demonstrated safety and effectiveness of antimuscarinic therapy in patients with BHP/BOO (bladder outlet obstruction), notably when combined with alpha-blockers. However long-term results of large prospective randomized studies are not available yet. Similarly, the stratification of patients according to their benefit from monotherapy or combination therapy has not been completed.
KEY WORDS:
overactive bladder, benign prostatic hyperplasia, treatment, male
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Labels
Paediatric urologist UrologyArticle was published in
Urological Journal
2009 Issue 2
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