A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting

Authors


  • Disclosures
    The manuscript is not under consideration elsewhere and none of the manuscript's contents have been previously published. All authors have read and approved the manuscript. Dr Matt Rosenberg has received consulting fees from Astellas Pharma Inc., GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Ortho-McNeil Pharmaceutical, Pfizer Inc., and Verathon Inc. He also has received fees from Esprit Pharma, Inc. and Ortho-McNeil Pharmaceutical for non-CME services, and he has conducted research on behalf of Sanofi-Aventis. Dr David Staskin has received intellectual property rights from or holds a patent with American Medical Systems. He has also received consulting fees and fees for non-CME services from Astellas Pharma Inc., Esprit Pharma, Inc. and Pfizer Inc. Dr Steven Kaplan has been a consultant for Allergan Inc., Astellas Pharma Inc., NeoTract Inc., Pfizer Inc. and Sanofi-Aventis. He has also participated in speakers’ bureaus for GlaxoSmithKline, Pfizer Inc. and Sanofi-Aventis. Dr Scott MacDiarmid has participated in speakers’ bureaus for Astellas Pharma Inc. and Novartis Pharmaceuticals Corporation. He has also participated in speakers’ bureaus and has been a consultant for Esprit Pharma, Inc., Ortho-McNeil Pharmaceutical, Pfizer Inc. and Watson Pharmaceuticals, Inc. Diane Newman has received consulting fees from Astellas Pharma Inc., GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Pfizer Inc., Sanofi-Aventis and Watson Pharmaceuticals, Inc. She has also performed contract research for Allergan Inc. and GTx, Inc. Dr Dana Ohl has received consulting fees from GlaxoSmithKline/Schering-Plough Corporation, Lilly and Pfizer Inc. He has also received fees from Auxilium Pharmaceuticals, GlaxoSmithKline, Lilly, Pfizer Inc. and Solvay Pharmaceuticals, Inc. for non-CME services. He has performed contract research for American Medical Systems and Bayer Pharmaceuticals Corporation, and has participated in a speakers’ bureau for Lilly. He has indicated that he holds ownership interest (in the form of stocks, stock options or other ownership interest excluding diversified mutual funds) in SD Science.

Matt T. Rosenberg, MD,
214 N. West Avenue, Jackson, MI 49201, USA
Tel.: + 1 517 784 9189
Fax: + 1 517 784 9657
Email: matttoren@yahoo.com

Summary

Aims:  Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient.

Results:  Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB).

Discussion:  This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm.

Conclusion:  Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically.

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