Guideline

Free Access

Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia

Corresponding Author

Yukio Homma

[email protected]

Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Correspondence: Yukio Homma M.D., Ph.D., Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: [email protected]Search for more papers by this author

Momokazu Gotoh,

Momokazu Gotoh

Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan

Search for more papers by this author

Akihiro Kawauchi,

Akihiro Kawauchi

Department of Urology, Shiga Medical University, Shiga, Japan

Search for more papers by this author

Yoshiyuki Kojima,

Yoshiyuki Kojima

Department of Urology, Fukushima Prefectural University of Medicine, Fukushima, Japan

Search for more papers by this author

Naoya Masumori,

Naoya Masumori

Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan

Search for more papers by this author

Atsushi Nagai,

Atsushi Nagai

Department of Urology, Kawasaki Medical School, Kurashiki, Japan

Search for more papers by this author

Tadanori Saitoh,

Tadanori Saitoh

Department of Urology, Sanikukai Hospital, Tokyo, Japan

Search for more papers by this author

Hideki Sakai,

Hideki Sakai

Department of Urology, Nagasaki University, Nagasaki, Japan

Search for more papers by this author

Satoru Takahashi,

Satoru Takahashi

Department of Urology, Nihon University, Tokyo, Japan

Search for more papers by this author

Osamu Ukimura,

Osamu Ukimura

Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Search for more papers by this author

Tomonori Yamanishi,

Tomonori Yamanishi

Department of Urology, Dokkyo Medical University, Tochigi, Japan

Search for more papers by this author

Osamu Yokoyama,

Osamu Yokoyama

Department of Urology, University of Fukui, Fukui, Japan

Search for more papers by this author

Masaki Yoshida,

Masaki Yoshida

Department of Urology, National Center of Geriatrics and Gerontology, Obu, Japan

Search for more papers by this author

Kenji Maeda,

Kenji Maeda

Department of Urology, Maeda Clinic of Internal Medicine, Ageo, Japan

Search for more papers by this author

Yukio Homma,

Corresponding Author

Yukio Homma

[email protected]

Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Momokazu Gotoh,

Momokazu Gotoh

Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan

Search for more papers by this author

Akihiro Kawauchi,

Akihiro Kawauchi

Department of Urology, Shiga Medical University, Shiga, Japan

Search for more papers by this author

Yoshiyuki Kojima,

Yoshiyuki Kojima

Department of Urology, Fukushima Prefectural University of Medicine, Fukushima, Japan

Search for more papers by this author

Naoya Masumori,

Naoya Masumori

Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan

Search for more papers by this author

Atsushi Nagai,

Atsushi Nagai

Department of Urology, Kawasaki Medical School, Kurashiki, Japan

Search for more papers by this author

Tadanori Saitoh,

Tadanori Saitoh

Department of Urology, Sanikukai Hospital, Tokyo, Japan

Search for more papers by this author

Hideki Sakai,

Hideki Sakai

Department of Urology, Nagasaki University, Nagasaki, Japan

Search for more papers by this author

Satoru Takahashi,

Satoru Takahashi

Department of Urology, Nihon University, Tokyo, Japan

Search for more papers by this author

Osamu Ukimura,

Osamu Ukimura

Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Search for more papers by this author

Tomonori Yamanishi,

Tomonori Yamanishi

Department of Urology, Dokkyo Medical University, Tochigi, Japan

Search for more papers by this author

Osamu Yokoyama,

Osamu Yokoyama

Department of Urology, University of Fukui, Fukui, Japan

Search for more papers by this author

Masaki Yoshida,

Masaki Yoshida

Department of Urology, National Center of Geriatrics and Gerontology, Obu, Japan

Search for more papers by this author

Kenji Maeda,

Kenji Maeda

Department of Urology, Maeda Clinic of Internal Medicine, Ageo, Japan

Search for more papers by this author

First published: 26 July 2017

https://doi.org/10.1111/iju.13401

Citations: 101

This is a translated summary of a full guideline published as a book in Japanese by The Japanese Urological Association, Clinical Guidelines for Male Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia, 2017. RichHill Medical, Tokyo.

Share a link

Email
Wechat
Bluesky

Abstract

The present article is the abbreviated English translation of the Japanese guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia updated as of the end of 2016. The target patients are men aged >50 years complaining of lower urinary tract symptoms, with or without benign prostatic hyperplasia, and the target readers are non-urological general physicians and urologists. Mandatory assessment for general physicians is medical history, physical examination, urinalysis and measurement of serum prostate-specific antigen. Additional mandatory assessment for urologists is symptoms and quality of life assessment by questionnaires, uroflowmetry, residual urine measurement, and prostate ultrasonography. Nocturia requires special attention, as it can result from nocturnal polyuria and/or sleep disturbance rather than lower urinary tract disorders. Functional lower urinary tract disorders with or without benign prostatic hyperplasia are primarily managed by conservative therapy and medications, such as α₁-blockers and phosphodiesterase-type 5 inhibitors. Use of other medications or combination pharmacotherapy is to be reserved for urologists. 5α-Reductase inhibitors and anticholinergics or β3 agonists are indicated for men with enlarged prostates and overactive bladder symptoms, respectively. Surgical intervention for bladder outlet obstruction is considered for persistent symptoms or benign prostatic hyperplasia-related comorbidities. Surgical modalities should be optimized by the patient's characteristics, performance of equipment and the surgeon's experience.

Abbreviations & Acronyms

BOO: bladder outlet obstruction
BPH: benign prostatic hyperplasia
ICS: International Continence Society
IPSS: International Prostate Symptom Score
JUA: Japanese Urological Association
LUTS: lower urinary tract symptoms
OAB: overactive bladder
PDE5i: phosphodiesterase 5 inhibitor
PSA: prostate-specific antigen
PVR: post-void residual
Q _max: maximum urinary flow rate
QOL: quality of life
RCT: randomized controlled trial
TURP: transurethral resection of the prostate

1 Introduction

Japanese clinical guidelines for male LUTS1 and those for BPH2 were published in 2009 and 2011, respectively. These guidelines have been combined and updated based on the evidence available as of the end of year 2016. The target subjects are men aged >50 years complaining of LUTS, with or without BPH, and the target readers are urologists and non-urologist general physicians. This article is the abbreviated English translation of the most updated Japanese guidelines for male LUTS and BPH.

2 Method

The Guidelines were developed by committee members recommended by the JUA and the Japanese Society of Internal Medicine. The members reviewed relevant references retrieved from the PubMed and Japana Centra Revuo Medicina databases released between 2010 and 2016. Other information sources included previous guidelines,1, 2 the BPH guidelines published by the American Urological Association3 and the European Association of Urology.4 A draft was peer-reviewed by JUA executive members and was open to public opinion before finalizing. Funding was provided by the JUA. Conflict of interest is regulated according to JUA bylaws.

3 Clinical algorithm

3.1 Algorithm for general physicians (Fig. 1)

The algorithm is applicable to men aged ≥50 years with male LUTS. The possible disorders include BPH, prostatitis, prostatic cancer, OAB, underactive bladder, bacterial cystitis, interstitial cystitis, bladder cancer, bladder stones, urethritis, urethral stricture, neuropathic diseases, polyuria and nocturnal polyuria.
The basic assessment comprises of present history, past history, physical examination, urinalysis and determination of serum PSA level. Optional assessments, selected on an individual basis, include symptom and QOL questionnaires, bladder diary, PVR measurement, urine culture, urine cytology, serum creatinine levels and prostate ultrasonography.
Referral to urologists is advised, when the assessments show “problematic” abnormalities, such as severe symptoms, and bladder or urethral pain; history of urinary retention, recurrent urinary tract infection, gross hematuria, pelvic surgery or radiotherapy and neurological disorders; bladder distention, a highly enlarged or painful prostate and prostate nodule; hematuria, febrile pyuria, elevated PSA, positive urinary cytology, PVR ≥100 mL, bladder stones, abnormality on imaging tests and renal insufficiency.
Afebrile pyuria should be treated by antibiotics, and referred to urologists when it persists or recurs.
Monosymptomatic nocturia can be caused by nocturnal polyuria and/or sleep disturbance. Overhydration, cardiac or renal insufficiency, hypertension, diabetes and sleep apnea syndrome are possible disorders. Voiding diary recording is recommended to diagnose them.
The most probable conditions here are BPH and/or bladder dysfunction. Confirm the patient's desire or medical need for treatment. On starting treatment, PVR measurement is recommended.
Conservative or behavior therapy and/or medical therapy using medicines, such as α₁-blocker or PDE5i, should be indicated. Remaining OAB symptoms might be improved by anticholinergics or β3 agonists; however, referral to urologists is recommended.
Monitor symptoms periodically, and consider cessation or reduction of medicines.

3.2 Algorithm for urologists (Fig. 2)

The algorithm is applicable to men aged ≥50 years with LUTS. The readers should consult Figure 1 first.
The basic assessment comprises of present history, past history, symptom and QOL questionnaires, physical examination, urinalysis, serum PSA level, uroflowmetry, PVR measurement, and prostate ultrasonography. Optional assessments include bladder diary, urine culture, urine cytology, advanced urodynamic studies, endoscopy, radiological examinations, serum creatinine levels and imaging tests for the upper urinary tract.
Consider other disorders, when the assessments reveal “problematic” abnormalities, such as severe symptoms, and bladder or urethral pain; history of urinary retention, recurrent urinary tract infection, gross hematuria, pelvic surgery or radiotherapy and neurological disorders; bladder distention, a highly enlarged or painful prostate and prostate nodule; hematuria, febrile pyuria, elevated PSA, positive urinary cytology, PVR ≥100 mL, bladder stones, abnormality on imaging tests and renal insufficiency.
When nocturia is the dominant symptom, voiding diary recording is recommended. Nocturnal polyuria, if present, should be managed by behavior therapy. Refer to clinical guidelines for persistent nocturia or nocturia without nocturnal polyuria.
Confirm the patient's desire or medical need for treatment of OAB symptoms without BPH. The symptoms are to be managed by conservative or behavior therapy and/or medical therapy with anticholinergic or β3 agonist. On starting treatment, PVR measurement is recommended. Refer to clinical guidelines for persistent OAB symptoms.
Confirm the patient's desire or medical need for treatment of BPH. BPH should be treated with conservative therapy or behavior therapy and/or medical therapy with α₁-blocker or PDE5i. Surgical indication might be considered.
Consider detrusor underactivity as one of the other disorders.
When the prostate is enlarged (≥30 mL), (co-)administration of 5α-reductase inhibitors is indicated. Anticholinergics and β3 agonists are indicated for persisting OAB symptoms.
Surgery is indicated for uncontrollable symptoms as a result of BOO and/or BPH-related complications. Pre-surgical tests should include a pressure-flow study or its substitutes including intravesical prostatic protrusion.

4 Clinical questions

CQ 1: What medications or lifestyles worsen male LUTS?

A number of medicines, especially those with anticholinergic property, are known to aggravate LUTS (level 4).1 Obesity, hypertension, hyperglycemia and dyslipidemia are associated with LUTS.5, 6

CQ 2: What considerations should be made when assessing serum PSA values?

Serum PSA value is a tumor marker of prostate cancer, but increased in men with enlarged adenoma, urinary retention and prostatitis. It is reduced to approximately 50% by long-term use of anti-androgens or 5α-reductase inhibitors.1, 2

CQ 3: When is bladder diary recording recommended for assessment of male LUTS?

A bladder diary provides useful information for the etiology of urinary frequency. It is recommended for men with LUTS, especially with overactive bladder symptoms and nocturia in particular (grade B).1, 2, 4

CQ 4: What managements are recommended for urinary retention?

At first indwelling catheter or intermittent catheterization is indicated, followed by assessment of the upper urinary tract and reasons for retention (level 5; grade A).7, 8 Catheter removal is anticipated by administration of α1-blockers and/or 5α-reductase inhibitors for BPH (level 1; grade B).9 Surgical intervention is likely to be required for large prostates.10

CQ 5: What managements are initially recommended for nocturia?

Bladder diary recording is recommended to differentiate 1-day polyuria, nocturnal polyuria, bladder storage dysfunction and sleep disturbance. Treatment should be individualized according to each etiology (grade B).11-13

CQ 6: What conservative treatments are recommended for male LUTS?

Weight reduction is recommended for severe obesity (level 1; grade A).14, 15 Integrated behavioral therapy is recommended for LUTS, storage symptoms in particular (level 2; grade B).16, 17 Exercise, balanced diet and smoking cessation are also recommended (level 4; grade C1).1 Pelvic floor exercise and bladder training are recommended for OAB symptoms persisting after use of α1-blockers (level 2; grade B).18

CQ 7: Is there a type-dependent difference of α1-blockers in the efficacy and safety for BPH?

Efficacy appears to be equivalent among α1 subtypes (level 2),19, 20 although storage symptoms might be different.21 Adverse events, such as dizziness, hypotension, ejaculation dysfunction and intraoperative floppy iris syndrome, are variable among the types (level 2).22-26

CQ 8: Is there a difference between α1-blockers and PDE5i in the efficacy for BPH?

The efficacy of α1-blockers (as far as tamsulosin is concerned) and PDE5i for BPH is almost equivalent (level 2; grade B).27-29 PDE5i has efficacy for erectile dysfunction (ED); however, it is indicated differently in terms of dose and usage.

CQ 9: Is combined therapy of α1-blockers and PDE5i recommended for BPH?

Combined therapy of α1-blockers and PDE5i improves IPSS and Q_max better than monotherapy (level 2; grade C1). A concern is the increased risk of a cardiovascular event, such as orthostatic hypotension. Hypotension is more likely to occur with non-selective α1-blockers (i.e. doxazocin) than prostate-selective α1-blockers (i.e. tamsulosin and silodosin).28, 30-33

CQ 10: Is alternative medicine (i.e. health food and supplements) recommended for male LUTS?

Evidence supports the efficacy of some alternative medicines; however, it is not recommended because of inconsistency in results of efficacy, uncertainty in optimum dosage and concern about unclarified adverse events (level 1–2; grade C2).34-40

CQ 11: Is combined therapy of α1-blockers and anticholinergics or β3-agonists recommended for BPH-associated OAB symptoms?

Combined therapy of α1-blockers and anticholinergics is recommended for OAB symptoms associated with BPH (level 1; grade A).41-47 Combined therapy of α1-blockers and β3-agonists might be beneficial (level 3; grade C1).48, 49 In any case, anticholinergics or β3-agonists should be started carefully at low doses under monitoring voiding difficulty or urinary retention, especially for men with severe voiding symptoms, an enlarged prostate or advanced age. It is advisable to start α1-blockers first followed by the addition of anticholinergics or β3-agonists for persistent OAB symptoms.

CQ 12: Is combined therapy of α1-blockers and 5α-reductase inhibitors recommended for BPH?

Combined therapy of α1-blockers and 5α-reductase inhibitors is recommended for BPH with prostate volume >30 mL (level 1; grade A).50-53 Superiority of combined therapy to monotherapy of 5α-reductase inhibitors might be uncertain for BPH with prostates >60 mL.54

CQ 13: Is switching to monotherapy recommended after continuous combined therapy of α1-blockers and 5α-reductase inhibitors for BPH?

Most cases can switch to monotherapy of 5α-reductase inhibitors without symptom aggravation after combined therapy of α1-blockers and 5α-reductase inhibitors for 6 months to 1 year (level 2; grade C1).55, 56 Switching to monotherapy of α1-blockers might result in prostate regrowth and/or symptomatic worsening (level 4; grade C1).57 The outcomes of switching to monotherapy after combined therapy for longer than 1 year are unknown.

CQ 14: Is combined therapy of PDE5i and 5α-reductase inhibitors recommended for BPH?

Combined therapy of PDE5i and 5α-reductase inhibitors induces rapid improvement of LUTS with erectile function (level 2).58, 59 Long-term outcomes of combined therapy are uncertain, and the combination of dutasteride and tadalafil (both approved in Japan) has not been examined (reserved).

CQ 15: What treatments are recommended to avoid sexual dysfunction as an adverse event?

PDE5i are recommended to avoid ED. Surgical therapies other than holmium laser enucleation of the prostate and photoselective vaporization of the prostate might result in ED. Surgeries, α1-blockers, 5α-reductase inhibitors and anti-androgens should be avoided to prevent ejaculatory dysfunction. To retain libido, 5α-reductase inhibitors and especially anti-androgens should be avoided (level 1–2; grade A).24, 60-63

CQ 16: What should be attended to when physicians see men with BPH?

Some medicines, especially those with anticholinergic property, can exaggerate LUTS. Urethral catheter should be cautiously placed in men who experienced prostatic surgery to avoid urethral injury. Urinary retention after catheter removal should be managed by α1-blockers or intermittent catheterization (see CQ 4). Patients should be asked if they are taking α1-blockers and PDE5i, as α1-blockers can cause hypotension or intraoperative floppy iris syndrome, and combined use of PDE5i with nitrate or nitric oxide donors is contraindicated.64-66

CQ 17: When should urological consultation be considered for men with LUTS?

Consultation should be considered when: (i) history, symptoms or signs designated as “problematic” in the algorithm for general physicians are found; (ii) urinary tract infection recurs or persists despite appropriate medical therapy; and (iii) LUTS including nocturia are not successfully improved by behavioral therapy and/or medical therapy including α1-blockers and PDE5i (grade B).

CQ 18: When should the referral from urologists to general physicians be considered for men with LUTS?

The referral should be considered when appropriate management is undertaken for symptoms, history and signs that are potentially problematic to general physicians, and when stable management is anticipated by treatments or surveillance recommended for general physicians. Specific warning regarding the medicine or conditions for the patient should be attached.

5 Definition of male LUTS and BPH

5.1 Definition of LUTS

Classification and description of LUTS should be based on the ICS terminology standardization report.67 LUTS is divided into storage symptoms (i.e. frequency, urgency, incontinence), voiding symptoms (i.e. voiding difficulty, hesitancy), post-micturition symptoms (i.e. feeling of incomplete emptying) and others (i.e. bladder pain, syndromes). Common symptoms in men are nocturia, daytime frequency, voiding difficulty, feeling of incomplete emptying and urgency. Nocturia is the LUTS that most often impairs QOL. Assessment of LUTS is critical for diagnosis and outcome assessment, although LUTS is unreliable for predicting organ dysfunctions. Nocturia is unique; it is most common, often associated with non-urological conditions, such as nocturnal polyuria and sleep disturbance, and less related to other LUTS.1

Details are in the caption following the image — **Figure 1**
Open in figure viewer PowerPoint

Algorithm for general physicians. UTI, urinary tract infection.

Important terminology not defined in the ICS report includes underactive bladder, urinary retention, overflow incontinence and hypersensitive bladder. Underactive bladder is proposed as a symptom complex suggestive of detrusor underactivity, and is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling and a slow stream.68 Urinary retention signifies a condition in which the patient is unable to pass urine despite a large amount of urine accumulated in the bladder. Such patients might be incontinent, as intravesical pressure exceeds the urethral closure pressure, leading to urinary leakage (overflow incontinence). These terms are not recommended by the ICS report; however, urinary incontinence associated with chronic urinary retention must not be overlooked. Hypersensitive bladder is listed as a cause of bladder pain by the recent ICS terminology report.69 It refers to a bladder condition suggestive of sensory hyperactivity presenting with hypersensitive bladder symptoms (discomfort, pressure or pain in the bladder usually associated with urinary frequency and nocturia), but no proven bladder pathology or other explainable diseases.70

5.2 Definition of BPH

There is no uniform definition for BPH. The ICS report proposed the use of “BPH” exclusively as a histopathological term to refer to non-malignant hyperplasia of prostatic tissue, and coined a term “benign prostatic enlargement” (BPE) for an enlarged prostate and “benign prostatic obstruction” (BPO) for BOO. From a clinical and practical point of view, the current Guidelines keep BPH as a disease name, and have defined BPH as a disease with lower urinary tract dysfunction due to benign hyperplasia of the prostate, which is usually associated with enlargement of the prostate and lower urinary tract symptoms suggestive of bladder outlet obstruction.2

6 Epidemiology and natural history of LUTS and BPH

LUTS associated with or without BPH is common in men. It can wax and wane, but generally progresses with aging.71 A nationwide survey involving 4480 Japanese men and women aged ≥40 years was reported in 2003.72 The frequency of all LUTS increased with age. The most common symptoms in men and women are nocturia and daytime frequency. In men, they were followed by weak urinary stream, feeling of incomplete emptying, urinary urgency and urgency incontinence. The most bothersome symptom in men was nocturia. A large-scale study, which recruited 19 165 Western individuals aged ≥18 years, found that 62.5% of men and 66.6% of women were symptomatic, respectively. The most common symptom was nocturia in both men and women.73 The risk factors of LUTS include aging, lifestyles, ED and chronic lifestyle diseases.74-76

The prevalence of BPH depends on its definition, varying from 6% to 12% in Japanese men aged in their 60s and 70s. The risk factors of developing BPH are aging, normally functioning testicles and genetic trait.2 BPH is a progressive disease regardless of race/ethnicity or region.77 Risk factors for BPH progression are aging, lifestyles, prostate volume, elevated PSA, LUTS, impaired QOL and decreased urinary flow rate.78, 79 Lethal comorbidities related to BPH are rare.

7 Pathophysiology

The causes of LUTS in men aged ≥50 years are diverse, including disorders of the prostate and lower urinary tract, pathology of the nervous system, and miscellaneous (Table 1). The most common pathophysiology would be BPH, OAB, underactive bladder, cerebrovascular disorder, polyuria and their combination.1

Table 1. Possible diseases/disorders of male LUTS

1. Prostate and lower urinary tract

Prostate: benign prostatic hyperplasia, prostatitis, prostate cancer

Bladder: overactive bladder, underactive bladder, hypersensitive bladder, sensory underactivity, bladder cancer, bladder stones, bladder diverticulum, bacterial cystitis, interstitial cystitis

Urethra: urethritis, urethral stricture

2. Nervous system

Cerebral: cerebrovascular disorder, dementia, Parkinson's disease, multiple system atrophy, brain tumor, normal pressure hydrocephalus

Spinal cord: spinal cord injury, multiple sclerosis, spinal cord tumor, spinal infarction, spinal degenerative disease, spina bifida

Peripheral nerves: diabetic neuropathy, post-pelvic surgery

Other: autonomic hyperactivity

3. Miscellaneous

Drug-related, polyuria, sleep disorder, psychogenic, aging

BPH is highly prevalent in aged men, and associated is with various combinations of voiding and storage symptoms. It arises in the periurethral region of the prostrate, and is histologically comprised of stromal elements of smooth muscle and connective tissue, as well as glandular and luminal epithelial cells. Proliferative factors including sex hormones, inflammation and adrenergic nerve hyperactivity are all causative of prostate enlargement.80 The pathophysiology of BPH-related LUTS would be multifactorial. BOO by the enlarged prostate increases resistance to urinary flow, resulting in voiding symptoms. BOO also induces overdistension, ischemia, inflammation and oxidative stress of the bladder, which subsequently cause denervation hypersensitivity, modulation of detrusor properties and release of urothelial neurotransmitters (e.g. adenosine triphosphate, nitric oxide, prostaglandin and acetylcholine).2 These modulations of urothelium, nerves and detrusor combined with BOO account for a complex of storage or voiding symptoms of BPH. BPH can lead to clinically important complications, such as hematuria, bladder calculi, recurrent urinary tract infections, urinary retention and renal failure.

Independently of the prostate pathology, functional disorders of the bladder, such as OAB, underactive bladder, hypersensitive bladder or sensory underactivity, might result from ischemia, inflammation and oxidative stress of the bladder.81-86 Infection of the bladder or prostate, commonly associated with frequency, urgency and pain, can coexist with bladder stones or BPH. Frequency, urgency and pain might persist, despite antimicrobial medicine in interstitial cystitis, bladder cancer and bladder stones.

Many disorders of the central and peripheral nervous systems, and autonomic nervous system can cause LUTS.87, 88 Other important reasons for LUTS are drug-related adverse events, inappropriate lifestyle (such as overhydration), sleep disturbance and psychogenic disorders.89, 90

8 Diagnosis

Diagnosis of male LUTS is based on clinical history, symptoms and QOL assessment by questionnaires,91, 92 physical examination, urinalysis, serum PSA determination, bladder diary, uroflowmetry, PVR measurement, serum creatinine measurement, and ultrasonography of the prostate or upper urinary tract. Men with “problematic” abnormality should consult urologists. See the Algorithm section for details.

9 Treatment

Treatment for male LUTS and BPH consists of watchful waiting (no therapy), conservative therapy, pharmacotherapy, surgical therapy and others. Conservative therapy is applicable to most cases. Pharmacotherapy is usually indicated for BPH and/or OAB. Combined pharmacotherapy should be reserved for urologists. Surgical therapy is usually directed to men resistant to pharmacotherapy.

The grades of recommendation for treatments (Table 2) were determined through committee discussion and consensus, based on the level of evidence (Table 3), as well as variability of study results, magnitude of effect, clinical applicability, adverse events and cost. Treatment recommendations are summarized in Table 4.

Table 2. Grade of recommendation

Grade	Nature of recommendation
A	Highly recommended
B	Recommended
C	No clear recommendation possible
C1	Can be considered
C2	Not recommended
D	Recommended not to do
Reserved	No recommendation made

Table 3. Levels of evidence

Level of evidence	Type of evidence
1	Evidence obtained from multiple RCTs
2	Evidence obtained from a single RCT or low quality RCTs
3	Evidence obtained from non-randomized controlled studies
4	Evidence obtained from observational studies or case series
5	Evidence obtained from case studies or expert opinions

Table 4. Treatment recommendations

Treatment	Grade
Watchful waiting and conservative therapy
Watchful waiting	B
Behavior modification	A, B and C1
Pelvic floor exercise, bladder training	A and B
Magnetic or electric stimulation	Reserved
Pharmacotherapy
BPH
α₁-Blockers (α₁-adrenoceptor antagonists)
Tamsulosin, naftopidil, silodosin, terazosin, urapidil	A
Prazosin	C1
PDE5i
Tadalafil	A
Sildenafil, vardenafil	Reserved
5α-Reductase inhibitors
Dutasteride	A
Finasteride	Reserved
Anti-androgens (chlormadinone, allylestrenol)	C1
Others
Eviprostat^®, Cernilton^®, Paraprost^®, Chinese herbal medicines (Hachimi-jio-gan^®, Gosha-jinki-gan^®)	C1
OAB and other conditions
Anticholinergics (oxybutynin, propiverine, tolterodine, solifenacin, imidafenacin, fesoterodine)	B C1 (with BPH)
β3-adrenoceptor agonists (mirabegron)	C1
Others (flavoxate, antidepressants, cholinergics)	C1
Alternative medicine	C2
Combined therapy
α₁-Blockers and anticholinergics	A
α₁-Blockers and β3-adrenoceptor agonists	C1
α₁-Blockers and 5α-reductase inhibitors	A
PDE5i and 5α-reductase inhibitors	Reserved
5α-Reductase inhibitors and anticholinergics or β3-adrenoceptor agonists	C1
Surgical therapy
Subcapsular enucleation
Open prostatectomy	A
Laparoscopic or robot-assisted prostatectomy	Reserved
Transurethral resection of the prostate (TURP)	A
Transurethral incision of the prostate (TUIP)	A
Transurethral enucleation with bipolar system (TUEB^®)	B
Holmium laser enucleation of the prostate (HoLEP)	A
Photoselective vaporization of the prostate by KTP laser (PVP)	A
Holmium laser ablation of the prostate (HoLAP)	B
Diode laser vaporization of the prostate	C1
Thulium laser resection of the prostate	B
Interstitial laser coagulation of the prostate (ILCP)	C1
High-intensity focused ultrasound (HIFU)	C1
Transurethral needle ablation (TUNA^®)	C1
Transurethral microwave thermotherapy (TUMT)	B
Urethral stent	C1
Prostatic urethral lift, water vapor, prostatic arterial embolization	Reserved
Others
Indwelling catheterization	C1
Intermittent catheterization	B

9.1 Watchful waiting (grade B)

BPH without bothersome symptoms or complications might require no treatment, as long as appropriate follow up is undertaken (level 4).93

9.2 Conservative therapies

Behavior modification (A, B and C1)

Weight reduction in obese men decreased urinary incontinence (level 1; grade A)14, 15. Integrated behavior therapy consisting of education, avoiding excessive fluid intake, bladder training and other measures significantly improved storage symptoms (level 2; grade B).16, 17 Exercise, dietary modification or smoking cessation can improve LUTS (level 4; grade C1).94 These lifestyle changes are the least invasive and inexpensive.

Pelvic floor exercise, bladder training (A and B)

Pelvic floor exercise and bladder training, especially directed by physiotherapists, improved OAB symptoms in men (level 2; grade B)18, 95 and post-prostatectomy incontinence (level 1; grade A).96

Magnetic or electric stimulation (reserved)

Pelvic floor electrical stimulation has efficacy evidence for post-prostatectomy incontinence (level 2).97 Bladder interferential stimulation alone is approved in Japan.

9.3 Pharmacotherapy for BPH

α1-Blockers (A)

By inhibiting contractions mediated by prostatic α₁-adrenoceptors, α₁-blockers reduce BOO and bring about prompt symptom improvement; 30–40% (4–6 point) reduction in the average IPSS, and 20–25% (2.0–2.5 mL/s) increase in Q_max (level 1).1, 2 Tamsulosin, naftopidil, silodosin, terazosin, urapidil and prazosin are approved in Japan, and are apparently of comparable efficacy. The former three have shown ample evidence for efficacy.21, 24, 25, 98-103 Postural hypotension and asthenia can occur as rarely as a placebo (4–10%). Significant adverse events include ejaculatory dysfunction and intraoperative floppy iris syndrome.

PDE5i (A)

PDE5i relaxes the smooth muscle of the prostate and urethra by inhibiting degradation of cyclic guanosine monophosphate and increasing nitric oxide concentration, improving LUTS associated with BPH (level 1).104 The average IPSS decreases by 2.35–4.21 points, whereas Q_max shows marginally or no significant increase of 0.01–1.43 mL/s.62, 105-108 Tadalafil alone is approved in Japan.29, 109, 110 Administration to men with high cardiovascular risks or combined use with nitrate is contraindicated.111

5α-Reductase inhibitors (A)

5α-Reductase inhibitors suppress conversion of testosterone to dihydrotestosterone, reducing biological activities of the prostate and relieving LUTS associated with BPH.50, 112, 113 A Japanese phase III trial of dutasteride in men with prostatic volume ≥30 mL showed an IPSS reduction by 5.3 points, Q_max increase by 2.2 mL/s and prostatic volume reduction by 22% (level 1).114 Sexual dysfunction can occur as an adverse event, and PSA levels decrease approximately by half. Dutasteride alone is approved in Japan.

Anti-androgens (C1)

Chlormadinone and allylestrenol suppress prostate growth by inhibiting pituitary secretion of gonadotropin, and testosterone action in the prostate. The efficacy is not supported by a high level of evidence (level 2).2, 115 Various adverse effects including severe sexual dysfunction can occur.

Others (C1)

Outdated or low-level evidence supports the efficacy for medicines of plant extracts and Chinese herbal medicines (level 2). Adverse reactions are rare and minor.2, 116, 117

9.4 Pharmacotherapy for OAB and other conditions

Anticholinergics (B, C1)

Anticholinergics approved in Japan (oxybutynin, propiverine, tolterodine, solifenacin, imidafenacin and fesoterodine) have a high level of evidence for improving OAB symptoms, although the study cohorts were mostly of women (level 1; grade B).45 For men with BOO, the efficacy is limited (level 1; grade C1), and the safety concern, such as voiding difficulty, is not resolved.118 α1-Blockers should be first administered to OAB with BPH, and anticholinergics are to be combined when α1-blocker monotherapy is insufficient (level 1).41-47

β3-Adrenoceptor agonists (C1)

Mirabegron reduces detrusor tonus by stimulating β3-adrenoceptors. Its efficacy for OAB is shown for women and men,119-124 but limited for men with BPH (level 3).125 Safety concerns remain for voiding difficulty, although dry mouth and constipation, often seen in anticholinergics, are rare.

Flavoxate and antidepressants (C1)

There is some evidence for flavoxate and antidepressants improving LUTS (level 2), although they are not approved for BPH or OAB. Drowsiness is an adverse event of antidepressants.1

Cholinergics (C1 for urologists, C2 for non-urologists)

Cholinergics are approved for voiding difficulty as a result of detrusor underactivity; however, the efficacy is negated (level 1).1 Adverse events, such as diarrhea, angina and especially cholinergic crises, are serious concerns. Cholinergics are contraindicated for BOO. They can be used by urologists with special care.

9.4.1 Alternative medicine (C2)

High-level evidence to support both efficacy and inefficacy is mixed (level 1). Inconsistent efficacy results, uncertain safety and high cost born by patients are concerns (see CQ 10).1

9.5 Combined pharmacotherapy

α1-Blockers and anticholinergics (A)

See CQ 11.

α1-Blockers and β3-adrenoceptor agonists (C1)

See CQ 11.

α1-Blockers and 5α-reductase inhibitors (A)

See CQ 12 and CQ 13.

PDE5i and 5α-reductase inhibitors (reserved)

See CQ 14.

5α-Reductase inhibitors and anticholinergics or β3-adrenoceptor agonists (C1)

The combination is potentially an alternative therapy for OAB associated with BPH, but not supported by sufficient evidence (level 4).126, 127

9.6 Surgical therapy

Surgery is indicated for persistent LUTS despite conservative or medical therapies, or BPH-related comorbidities, such as urinary retention. Less invasive surgery using new energy sources is presently evolving. Resection/vaporization of the enlarged prostate appear to be more effective. Selection of surgical modalities depends on the patient's characteristics, performance of equipment available and the surgeon's experience.

Enucleation

(a) Open surgery (A)

This classic technique is a standard surgery for en bloc enucleation of large prostates.128, 129

(b) Laparoscopic and robot-assisted laparoscopic surgeries (reserved)

These modalities appear to be less invasive than open surgery, although evidence for long-term efficacy and safety is lacking.130-132

TURP: Monopolar or bipolar (A)

TURP is the standard surgical technique usually used for moderate size prostates (30–80 mL). Hemorrhage or hyponatremia by irrigation fluids (TUR syndrome) can occur.133-135 Bipolar TURP is less likely to induce TUR syndrome.136, 137

Transurethral incision of the prostate (A)

This technique has short-term efficacy comparable with TURP, with a lower risk of complications. It is applicable to relatively small size prostates (<30 mL).134, 138, 139

Transurethral enucleation with bipolar system (B)

It is applicable to moderate-to-large size prostates, and is as efficacious as TURP or open enucleation surgery.140-142

Holmium laser enucleation of the prostate (A)

Holmium laser has a high absorbance rate by water. Sufficient evidence supports its efficacy comparable with TURP or open surgery.143-145

Photoselective vaporization of the prostate by KTP laser (A)

KTP laser has a high absorbance rate by hemoglobin. There is sufficient evidence for its efficacy comparable with TURP or open surgery. Men taking anti-coagulants can be safely operated.146-148

Diode laser vaporization of the prostate (C1)

Diode laser is absorbed by water and hemoglobin. Evidence for long-term efficacy in comparison with TURP or open surgery is not sufficient.149, 150

Thulium laser resection vaporization of the prostate (B)

Evidence supports its long-term efficacy comparable with TURP or open surgery. Men taking anti-coagulants can be safely operated.151-154

Interstitial laser coagulation of the prostate (C1)

The treatment is as effective as TURP for the short-term, although almost half of patients require further treatments in long-term follow up.2

Transrectal high-intensity focused ultrasound (C1)

Reports on efficacy and safety are limited. Re-intervention is required in half of cases.2

Transurethral needle ablation (C1)

Medium-term efficacy is comparable with TURP. Re-treatment or perioperative irritative symptoms are seen in nearly half of cases.2

Transurethral microwave therapy (B)

Medium-term efficacy has been repeatedly shown, even for large prostates. Almost half of cases require further interventions.2

Urethral stent (C1)

It is indicated for high-risk or surgery-contraindicated patients. Complications that require stent removal can occur.155, 156

Prostatic urethral lift (reserved)

Efficacy almost comparable with TURP is shown. Some cases require further interventions.157-159 It is not approved in Japan.

Water vapor (reserved)

There is some evidence to support efficacy, although long-term efficacy is uncertain.160 It is not approved in Japan.

Prostatic arterial embolization (reserved)

Evidence to support efficacy is lacking. It would be an experimental therapy.161

9.7 Other treatments

Indwelling catheterization (C1)

It is indicated if other treatments are impractical. High complication rates and/or QOL impairment are associated.8, 162

Intermittent catheterization (B)

Compared with indwelling catheterization, urinary tract infection is less frequent and early recovery of bladder function is more likely.162

10 BPH treatment and sexual function

Treatments for BPH can impact adversely on sexual function. Surgical interventions often result in ejaculatory dysfunction60, 163; α₁-blockers sometimes cause ejaculatory dysfunction24; and 5α-reductase inhibitors and anti-androgens result in multiple sexual dysfunctions, being more severe for the latter.164 See CQ 15.

11 Clinical study

This section makes some recommendations for clinical studies on BPH treatment.2

11.1 Inclusion/exclusion criteria

Men aged ≥50 years, with symptoms suggestive of BPH (i.e. IPSS ≥8) and QOL impairment (i.e. QOL score ≥2), with prostate enlargement (i.e. PV ≥20 mL) and lower urinary flow rate (i.e. Q_max <15 mL/s), would be candidates for the study. Exclusion criteria might include suspicion or presence of diseases other than BPH, persisting effects of precedent treatments or conflicts with the characteristic of the treatment.

11.2 Criteria for severity and therapeutic efficacy

Severity and efficacy can be assessed by the values or the value changes of IPSS, QOL index, scores of other questionnaires (BPH impact index, King's Health Questionnaire and Short Form-36), prostate volume, or flow rate. The cut-offs of these values for severity or efficacy criteria have been suggested.

Conflict of interest

Yukio Homma received research grants from Astellas, Asahikasei, DaiichiSankyo, Ono, Takeda and Nippon Shinyaku, and received lecture fees from Astellas and Integral; Momokazu Gotoh received research grants from Astellas, DaiichiSankyo, Ono and Takeda, and received lecture fees from Astellas, Pfizer, Kissei, Kyorin, Taiho and DaiichiSankyo; Akihiro Kawauchi received research grants from Astellas; Yoshiyuki Kojima received research grants from Takeda and received lecture fees from Astellas; Naoya Masumori received research grants from Astellas and Takeda, and received lecture fees from Astellas, Nippon Shinyaku, Asahikasei, Astra Zeneca and Kissei; Atsushi Nagai received research grants from Nippon Shinyaku, Takeda, Astellas, Ono and Kissei, and received lecture fees from Nippon Shinyaku and Pfizer; Hideki Sakai received research grants from Astellas, Takeda and Pfizer, and received lecture fees from Takeda; Satoru Takahashi received research grants from Astellas, Takeda, Nippon Shinyaku and Yamada-yohozyo, and received lecture fees from Astellas, Pfizer and Nippon Shinyaku; Osamu Ukimura received research grants from Astellas, Takeda, Nippon Shinyaku and Glaxosmithkline; Tomonori Yamanishi received research grants from Astellas; Osamu Yokoyama received research grants from Astellas, Taiho, Kissei, DaiichiSankyo, Ono, Pfizer, Bayer and Nippon Shinyaku, and received lecture fees from Pfizer, Astellas, Hisamitsu, Nippon Shinyaku, Kyorin, Glaxosmithkline, Kissei and Ono; Masaki Yoshida received grant from Astellas, and received lecture fees from Astellas, Kissei, Kyorin, Nippon Shinyaku; Tadanori Saitoh and Kenji Maeda have no conflict of interest. Funding for the committee meetings was provided by JUA.

References

1Homma Y, Araki I, Igawa Y et al. Clinical guideline for male lower urinary tract symptoms. Int. J. Urol. 2009; 16: 775–90.
10.1111/j.1442-2042.2009.02369.x
CAS PubMed Web of Science® Google Scholar
2Homma Y, Gotoh M, Yokoyama O et al. Outline of JUA clinical guidelines for benign prostatic hyperplasia. Int. J. Urol. 2011; 18: 741–56.
10.1111/j.1442-2042.2011.02860.x
CAS PubMed Web of Science® Google Scholar
3 American Urological Association. Management of benign prostatic hyperplasia (BPH), 2010. [Cited 22 Jun 2017]. Available from URL: http://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(2010-reviewed-and-validity-confirmed-2014).
Google Scholar
4 European Association of Urology. Treatment of non-neurogenic male LUTS. [Cited 22 Jun 2017]. Available from URL: https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/.
Google Scholar
5Moul S, McVary KT. Lower urinary tract symptoms, obesity and the metabolic syndrome. Curr. Opin. Urol. 2010; 20: 7–12.
10.1097/MOU.0b013e3283336f3f
PubMed Web of Science® Google Scholar
6Lin PH, Freedland SJ. Lifestyle and lower urinary tract symptoms: what is the correlation in men? Curr. Opin. Urol. 2015; 25: 1–5.
10.1097/MOU.0000000000000121
PubMed Web of Science® Google Scholar
7Ko YH, Kim JW, Kang SG et al. The efficacy of in-and-out catheterization as a way of trial without catheterization strategy for treatment of acute urinary retention induced by benign prostate hyperplasia: variables predicting success outcome. Neurourol. Urodyn. 2012; 31: 460–4.
10.1002/nau.21196
CAS PubMed Web of Science® Google Scholar
8Fitzpatrick JM, Desgrandchamps F, Adjali K et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012; 109: 88–95.
10.1111/j.1464-410X.2011.10430.x
PubMed Web of Science® Google Scholar
9Inahara M, Sugiura M, Kaga K et al. [Clinical outcomes after combined therapy with dutasteride in patients with unsuccessful trial without catheter after treatment with an alpha1-adrenergic receptor blocker monotherapy for acute urinary retention caused by prostatic hyperplasia]. Nihon Hinyokika Gakkai Zasshi 2014; 105: 190–5.
PubMed Google Scholar
10Guang-Jun D, Feng-Bin G, Xun-Bo J. Alpha(1)-blockers in the management of acute urinary retention secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. Ir. J. Med. Sci. 2015; 184: 23–30.
10.1007/s11845-014-1094-3
CAS PubMed Web of Science® Google Scholar
11 Committee for Establishment of the Clinical Guidelines for Nocturia of the Neurogenic Bladder Society. Clinical Guidelines for Nocturia. Int. J. Urol. 2010; 17: 397–409.
10.1111/j.1442-2042.2010.02527.x
CAS PubMed Web of Science® Google Scholar
12Cornu JN, Abrams P, Chapple CR et al. A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management–a systematic review and meta-analysis. Eur. Urol. 2012; 62: 877–90.
10.1016/j.eururo.2012.07.004
PubMed Web of Science® Google Scholar
13Marshall SD, Raskolnikov D, Blanker MH et al. Nocturia: current levels of evidence and recommendations from the international consultation on male lower urinary tract symptoms. Urology 2015; 85: 1291–9.
10.1016/j.urology.2015.02.043
PubMed Web of Science® Google Scholar
14Khoo J, Ling PS, Chen RY et al. Comparing the effects of meal replacements with an isocaloric reduced-fat diet on nutrient intake and lower urinary tract symptoms in obese men. J. Hum. Nutr. Diet. 2014; 27: 219–26.
10.1111/jhn.12151
PubMed Web of Science® Google Scholar
15Breyer BN, Phelan S, Hogan PE et al. Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: results from the Look AHEAD trial. J. Urol. 2014; 192: 144–9.
10.1016/j.juro.2014.02.036
PubMed Web of Science® Google Scholar
16Brown CT, Yap T, Cromwell DA et al. Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ 2007; 334: 25.
10.1136/bmj.39010.551319.AE
PubMed Web of Science® Google Scholar
17Yap TL, Brown C, Cromwell DA, van der Meulen J, Emberton M. The impact of self-management of lower urinary tract symptoms on frequency-volume chart measures. BJU Int. 2009; 104: 1104–8.
10.1111/j.1464-410X.2009.08497.x
PubMed Web of Science® Google Scholar
18Burgio KL, Goode PS, Johnson TM et al. Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial. J. Am. Geriatr. Soc. 2011; 59: 2209–16.
10.1111/j.1532-5415.2011.03724.x
PubMed Web of Science® Google Scholar
19Shim SR, Kim JH, Chang IH et al. Is tamsulosin 0.2 mg effective and safe as a first-line treatment compared with other alpha blockers? A meta-analysis and a moderator focused study. Yonsei Med. J. 2016; 57: 407–18.
10.3349/ymj.2016.57.2.407
CAS PubMed Web of Science® Google Scholar
20Fusco F, Palmieri A, Ficarra V et al. alpha1-blockers improve benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review and meta-analysis of urodynamic studies. Eur. Urol. 2016; 69: 1091–101.
10.1016/j.eururo.2015.12.034
CAS PubMed Web of Science® Google Scholar
21Matsukawa Y, Funahashi Y, Takai S et al. Comparison of silodosin and naftopidil for efficacy in the treatment of benign prostatic enlargement complicated by overactive bladder: a randomized, prospective study (SNIPER study). J. Urol. 2017; 197: 452–8.
10.1016/j.juro.2016.08.111
CAS PubMed Web of Science® Google Scholar
22Masumori N, Tsukamoto T, Iwasawa A et al. Ejaculatory disorders caused by alpha-1 blockers for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: comparison of naftopidil and tamsulosin in a randomized multicenter study. Urol. Int. 2009; 83: 49–54.
10.1159/000224868
CAS PubMed Web of Science® Google Scholar
23Yoshimura K, Kadoyama K, Sakaeda T, Sugino Y, Ogawa O, Okuno Y. A survey of the FAERS database concerning the adverse event profiles of alpha1-adrenoreceptor blockers for lower urinary tract symptoms. Int. J. Med. Sci. 2013; 10: 864–9.
10.7150/ijms.5892
CAS PubMed Web of Science® Google Scholar
24Yokoyama T, Hara R, Fukumoto K et al. Effects of three types of alpha-1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia. Int. J. Urol. 2011; 18: 225–30.
10.1111/j.1442-2042.2010.02708.x
CAS PubMed Web of Science® Google Scholar
25Yamaguchi K, Aoki Y, Yoshikawa T, Hachiya T, Saito T, Takahashi S. Silodosin versus naftopidil for the treatment of benign prostatic hyperplasia: a multicenter randomized trial. Int. J. Urol. 2013; 20: 1234–8.
10.1111/iju.12160
CAS PubMed Web of Science® Google Scholar
26Chang DF, Campbell JR, Colin J, Schweitzer C, Study Surgeon G. Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin. Ophthalmology 2014; 121: 829–34.
10.1016/j.ophtha.2013.10.031
PubMed Web of Science® Google Scholar
27Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur. Urol. 2012; 61: 917–25.
10.1016/j.eururo.2012.01.013
CAS PubMed Web of Science® Google Scholar
28Gacci M, Corona G, Salvi M et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur. Urol. 2012; 61: 994–1003.
10.1016/j.eururo.2012.02.033
CAS PubMed Web of Science® Google Scholar
29Yokoyama O, Yoshida M, Kim SC et al. Tadalafil once daily for lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a randomized placebo- and tamsulosin-controlled 12-week study in Asian men. Int. J. Urol. 2013; 20: 193–201.
10.1111/j.1442-2042.2012.03130.x
CAS PubMed Web of Science® Google Scholar
30Gacci M, Vittori G, Tosi N et al. A randomized, placebo-controlled study to assess safety and efficacy of vardenafil 10 mg and tamsulosin 0.4 mg vs. tamsulosin 0.4 mg alone in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J. Sex. Med. 2012; 9: 1624–33.
10.1111/j.1743-6109.2012.02718.x
CAS PubMed Web of Science® Google Scholar
31Yan H, Zong H, Cui Y, Li N, Zhang Y. The efficacy of PDE5 inhibitors alone or in combination with alpha-blockers for the treatment of erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and meta-analysis. J. Sex. Med. 2014; 11: 1539–45.
10.1111/jsm.12499
CAS PubMed Web of Science® Google Scholar
32Wang X, Wang X, Li S, Meng Z, Liu T, Zhang X. Comparative effectiveness of oral drug therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and network meta-analysis. PLoS ONE 2014; 9: e107593.
10.1371/journal.pone.0107593
PubMed Web of Science® Google Scholar
33Goldfischer E, Kowalczyk JJ, Clark WR et al. Hemodynamic effects of once-daily tadalafil in men with signs and symptoms of benign prostatic hyperplasia on concomitant alpha1-adrenergic antagonist therapy: results of a multicenter randomized, double-blind, placebo-controlled trial. Urology 2012; 79: 875–82.
10.1016/j.urology.2011.11.040
PubMed Web of Science® Google Scholar
34Espinosa G. Nutrition and benign prostatic hyperplasia. Curr. Opin. Urol. 2013; 23: 38–41.
10.1097/MOU.0b013e32835abd05
PubMed Web of Science® Google Scholar
35Morgia G, Russo GI, Voce S et al. Serenoa repens, lycopene and selenium versus tamsulosin for the treatment of LUTS/BPH. An Italian multicenter double-blinded randomized study between single or combination therapy (PROCOMB trial). Prostate 2014; 74: 1471–80.
10.1002/pros.22866
CAS PubMed Web of Science® Google Scholar
36Adorini L, Penna G, Fibbi B, Maggi M. Vitamin D receptor agonists target static, dynamic, and inflammatory components of benign prostatic hyperplasia. Ann. N. Y. Acad. Sci. 2010; 1193: 146–52.
10.1111/j.1749-6632.2009.05299.x
CAS PubMed Web of Science® Google Scholar
37Wong WC, Wong EL, Li H et al. Isoflavones in treating watchful waiting benign prostate hyperplasia: a double-blinded, randomized controlled trial. J. Altern. Complement. Med. 2012; 18: 54–60.
10.1089/acm.2010.0077
PubMed Web of Science® Google Scholar
38Barry MJ, Meleth S, Lee JY et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 2011; 306: 1344–51.
10.1001/jama.2011.1364
CAS PubMed Web of Science® Google Scholar
39MacDonald R, Tacklind JW, Rutks I, Wilt TJ. Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012; 109: 1756–61.
10.1111/j.1464-410X.2012.11172.x
CAS PubMed Web of Science® Google Scholar
40Scaglione F, Lucini V, Pannacci M, Dugnani S, Leone C. Comparison of the potency of 10 different brands of Serenoa repens extracts. Eur. Rev. Med. Pharmacol. Sci. 2012; 16: 569–74.
CAS PubMed Web of Science® Google Scholar
41Chapple CR, Herschorn S, Abrams P, Wang JT, Brodsky M, Guan Z. Efficacy and safety of tolterodine extended-release in men with overactive bladder symptoms treated with an alpha-blocker: effect of baseline prostate-specific antigen concentration. BJU Int. 2010; 106: 1332–8.
10.1111/j.1464-410X.2010.09359.x
CAS PubMed Web of Science® Google Scholar
42Nishizawa O, Yamaguchi O, Takeda M, Yokoyama O, Group TS. Randomized controlled trial to treat benign prostatic hyperplasia with overactive bladder using an alpha-blocker combined with anticholinergics. Low. Urin. Tract Symptoms 2011; 3: 29–35.
10.1111/j.1757-5672.2010.00081.x
CAS PubMed Web of Science® Google Scholar
43Yamaguchi O, Kakizaki H, Homma Y et al. Solifenacin as add-on therapy for overactive bladder symptoms in men treated for lower urinary tract symptoms–ASSIST, randomized controlled study. Urology 2011; 78: 126–33.
10.1016/j.urology.2011.02.055
PubMed Web of Science® Google Scholar
44Kaplan SA, Roehrborn CG, Gong J, Sun F, Guan Z. Add-on fesoterodine for residual storage symptoms suggestive of overactive bladder in men receiving alpha-blocker treatment for lower urinary tract symptoms. BJU Int. 2012; 109: 1831–40.
10.1111/j.1464-410X.2011.10624.x
CAS PubMed Web of Science® Google Scholar
45Takeda M, Nishizawa O, Gotoh M, Yoshida M, Takahashi S, Masumori N. Clinical efficacy and safety of imidafenacin as add-on treatment for persistent overactive bladder symptoms despite alpha-blocker treatment in patients with BPH: the ADDITION study. Urology 2013; 82: 887–93.
10.1016/j.urology.2013.05.008
PubMed Web of Science® Google Scholar
46Filson CP, Hollingsworth JM, Clemens JQ, Wei JT. The efficacy and safety of combined therapy with alpha-blockers and anticholinergics for men with benign prostatic hyperplasia: a meta-analysis. J. Urol. 2013; 190: 2153–60.
10.1016/j.juro.2013.05.058
CAS PubMed Web of Science® Google Scholar
47Gong M, Dong W, Huang G et al. Tamsulosin combined with solifenacin versus tamsulosin monotherapy for male lower urinary tract symptoms: a meta-analysis. Curr. Med. Res. Opin. 2015; 31: 1781–92.
10.1185/03007995.2015.1074067
CAS PubMed Web of Science® Google Scholar
48van Gelderen M, Tretter R, Meijer J et al. Absence of clinically relevant cardiovascular interaction upon add-on of mirabegron or tamsulosin to an established tamsulosin or mirabegron treatment in healthy middle-aged to elderly men. Int. J. Clin. Pharmacol. Ther. 2014; 52: 693–701.
10.5414/CP201979
CAS PubMed Web of Science® Google Scholar
49Ichihara K, Masumori N, Fukuta F, Tsukamoto T, Iwasawa A, Tanaka Y. A randomized controlled study of the efficacy of tamsulosin monotherapy and its combination with mirabegron for overactive bladder induced by benign prostatic obstruction. J. Urol. 2015; 193: 921–6.
10.1016/j.juro.2014.09.091
CAS PubMed Web of Science® Google Scholar
50Roehrborn CG, Siami P, Barkin J et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur. Urol. 2010; 57: 123–31.
10.1016/j.eururo.2009.09.035
CAS PubMed Web of Science® Google Scholar
51Roehrborn CG, Oyarzabal Perez I, Roos EP et al. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart((R))) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naive men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results. BJU Int. 2015; 116: 450–9.
10.1111/bju.13033
CAS PubMed Web of Science® Google Scholar
52Chung BH, Lee SH, Roehrborn CG et al. Comparison of the response to treatment between Asian and Caucasian men with benign prostatic hyperplasia: long-term results from the combination of dutasteride and tamsulosin study. Int. J. Urol. 2012; 19: 1031–5.
10.1111/j.1442-2042.2012.03091.x
PubMed Web of Science® Google Scholar
53Hashimoto M, Shimizu N, Sugimoto K et al. Efficacy of adding dutasteride to alpha-blocker therapy treated benign prostatic hyperplasia patients with small volume prostate (<30 mL). Low. Urin. Tract Symptoms 2016; https://doi.org/10.1111/luts.12127.
PubMed Web of Science® Google Scholar
54Roehrborn CG, Barkin J, Tubaro A et al. Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study. BJU Int. 2014; 113: 623–35.
10.1111/bju.12500
CAS PubMed Web of Science® Google Scholar
55Barkin J, Guimaraes M, Jacobi G, Pushkar D, Taylor S, van Vierssen Trip OB. Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride. Eur. Urol. 2003; 44: 461–6.
10.1016/S0302-2838(03)00367-1
CAS PubMed Web of Science® Google Scholar
56Lee JY, Kang DH, Park SY et al. Effect of discontinuation of tamsulosin in Korean men with benign prostatic hyperplasia taking tamsulosin and dutasteride: an open-label, prospective, randomized pilot study. Low. Urin. Tract Symptoms 2012; 4: 35–40.
10.1111/j.1757-5672.2011.00109.x
CAS Web of Science® Google Scholar
57Shindo T, Hashimoto K, Shimizu T, Itoh N, Masumori N. Significance of intraprostatic architecture and regrowth velocity for considering discontinuation of dutasteride after combination therapy with an alpha blocker: a prospective, pilot study. Korean J. Urol. 2015; 56: 305–9.
10.4111/kju.2015.56.4.305
PubMed Web of Science® Google Scholar
58Casabe A, Roehrborn CG, Da Pozzo LF et al. Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J. Urol. 2014; 191: 727–33.
10.1016/j.juro.2013.09.059
CAS PubMed Web of Science® Google Scholar
59Roehrborn CG, Casabe A, Glina S, Sorsaburu S, Henneges C, Viktrup L. Treatment satisfaction and clinically meaningful symptom improvement in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia: secondary results from a 6-month, randomized, double-blind study comparing finasteride plus tadalafil with finasteride plus placebo. Int. J. Urol. 2015; 22: 582–7.
10.1111/iju.12741
PubMed Web of Science® Google Scholar
60Elshal AM, Elmansy HM, Elkoushy MA, Elhilali MM. Male sexual function outcome after three laser prostate surgical techniques: a single center perspective. Urology 2012; 80: 1098–104.
10.1016/j.urology.2012.08.001
PubMed Web of Science® Google Scholar
61Giuliano F, Oelke M, Jungwirth A et al. Tadalafil once daily improves ejaculatory function, erectile function, and sexual satisfaction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and erectile dysfunction: results from a randomized, placebo- and tamsulosin-controlled, 12-week double-blind study. J. Sex. Med. 2013; 10: 857–65.
10.1111/jsm.12039
CAS PubMed Web of Science® Google Scholar
62Brock G, Broderick G, Roehrborn CG, Xu L, Wong D, Viktrup L. Tadalafil once daily in the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in men without erectile dysfunction. BJU Int. 2013; 112: 990–7.
10.1111/bju.12251
CAS PubMed Web of Science® Google Scholar
63Glina S, Roehrborn CG, Esen A et al. Sexual function in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia: results of a 6-month, randomized, double-blind, placebo-controlled study of tadalafil coadministered with finasteride. J. Sex. Med. 2015; 12: 129–38.
10.1111/jsm.12714
CAS PubMed Web of Science® Google Scholar
64Kowalik U, Plante MK. Urinary retention in surgical patients. Surg. Clin. North Am. 2016; 96: 453–67.
10.1016/j.suc.2016.02.004
PubMed Web of Science® Google Scholar
65Alan McNeill S. The role of alpha-blockers in the management of acute urinary retention caused by benign prostatic obstruction. Eur. Urol. 2004; 45: 325–32.
10.1016/j.eururo.2003.10.001
CAS PubMed Web of Science® Google Scholar
66Oelke M, Gericke A, Michel MC. Cardiovascular and ocular safety of alpha1-adrenoceptor antagonists in the treatment of male lower urinary tract symptoms. Expert Opin. Drug Saf. 2014; 13: 1187–97.
10.1517/14740338.2014.936376
CAS PubMed Web of Science® Google Scholar
67Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn. 2002; 21: 167–78.
10.1002/nau.10052
PubMed Web of Science® Google Scholar
68Chapple CR, Osman NI, Birder L et al. The underactive bladder: a new clinical concept? Eur. Urol. 2015; 68: 351–3.
10.1016/j.eururo.2015.02.030
PubMed Web of Science® Google Scholar
69Doggweiler R, Whitmore KE, Meijlink JM et al. A standard for terminology in chronic pelvic pain syndromes: a report from the chronic pelvic pain working group of the international continence society. Neurourol. Urodyn. 2017; 36: 984–1008.
10.1002/nau.23072
PubMed Web of Science® Google Scholar
70Homma Y. Hypersensitive bladder: a solution to confused terminology and ignorance concerning interstitial cystitis. Int. J. Urol. 2014; 21 (Suppl 1): 43–7.
10.1111/iju.12314
PubMed Web of Science® Google Scholar
71Maserejian NN, Chen S, Chiu GR et al. Treatment status and progression or regression of lower urinary tract symptoms in a general adult population sample. J. Urol. 2014; 191: 107–13.
10.1016/j.juro.2013.07.005
PubMed Web of Science® Google Scholar
72Homma Y, Yamaguchi O, Hayashi K, Neurogenic Bladder Society C. Epidemiologic survey of lower urinary tract symptoms in Japan. Urology 2006; 68: 560–4.
10.1016/j.urology.2006.03.035
PubMed Web of Science® Google Scholar
73Coyne KS, Sexton CC, Thompson CL et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009; 104: 352–60.
10.1111/j.1464-410X.2009.08427.x
PubMed Web of Science® Google Scholar
74Coyne KS, Kaplan SA, Chapple CR et al. Risk factors and comorbid conditions associated with lower urinary tract symptoms: EpiLUTS. BJU Int. 2009; 103 (Suppl 3): 24–32.
10.1111/j.1464-410X.2009.08438.x
PubMed Web of Science® Google Scholar
75Wong SY, Woo J, Leung JC, Leung PC. Depressive symptoms and lifestyle factors as risk factors of lower urinary tract symptoms in Southern Chinese men: a prospective study. Aging Male 2010; 13: 113–9.
10.3109/13685530903440432
PubMed Web of Science® Google Scholar
76Smith DP, Weber MF, Soga K et al. Relationship between lifestyle and health factors and severe lower urinary tract symptoms (LUTS) in 106,435 middle-aged and older Australian men: population-based study. PLoS ONE 2014; 9: e109278.
10.1371/journal.pone.0109278
PubMed Web of Science® Google Scholar
77Fukuta F, Masumori N, Mori M, Tsukamoto T. Natural history of lower urinary tract symptoms in Japanese men from a 15-year longitudinal community-based study. BJU Int. 2012; 110: 1023–9.
10.1111/j.1464-410X.2011.10866.x
PubMed Web of Science® Google Scholar
78Gacci M, Corona G, Vignozzi L et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis. BJU Int. 2015; 115: 24–31.
10.1111/bju.12728
PubMed Web of Science® Google Scholar
79Fukuta F, Masumori N, Mori M, Tsukamoto T. Internal prostatic architecture on transrectal ultrasonography predicts future prostatic growth: natural history of prostatic hyperplasia in a 15-year longitudinal community-based study. Prostate 2011; 71: 597–603.
10.1002/pros.21275
PubMed Web of Science® Google Scholar
80Shimizu S, Shimizu T, Tsounapi P et al. Effect of silodosin, an alpha1A-adrenoceptor antagonist, on ventral prostatic hyperplasia in the spontaneously hypertensive rat. PLoS ONE 2015; 10: e0133798.
10.1371/journal.pone.0133798
PubMed Web of Science® Google Scholar
81Yoshida M, Masunaga K, Nagata T, Satoji Y, Shiomi M. The effects of chronic hyperlipidemia on bladder function in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits. Neurourol. Urodyn. 2010; 29: 1350–4.
10.1002/nau.20843
CAS PubMed Web of Science® Google Scholar
82Yamaguchi O, Nomiya M, Andersson KE. Functional consequences of chronic bladder ischemia. Neurourol. Urodyn. 2014; 33: 54–8.
10.1002/nau.22517
PubMed Web of Science® Google Scholar
83Shimizu S, Saito M, Oiwa H et al. Olmesartan ameliorates urinary dysfunction in the spontaneously hypertensive rat via recovering bladder blood flow and decreasing oxidative stress. Neurourol. Urodyn. 2014; 33: 350–7.
10.1002/nau.22405
CAS PubMed Web of Science® Google Scholar
84Daly DM, Nocchi L, Liaskos M, McKay NG, Chapple C, Grundy D. Age-related changes in afferent pathways and urothelial function in the male mouse bladder. J. Physiol. 2014; 592: 537–49.
10.1113/jphysiol.2013.262634
CAS PubMed Web of Science® Google Scholar
85Kupelian V, Rosen RC, Roehrborn CG, Tyagi P, Chancellor MB, McKinlay JB. Association of overactive bladder and C-reactive protein levels. Results from the Boston Area Community Health (BACH) Survey. BJU Int. 2012; 110: 401–7.
10.1111/j.1464-410X.2011.10769.x
CAS PubMed Web of Science® Google Scholar
86Liu HT, Jiang YH, Kuo HC. Increased serum adipokines implicate chronic inflammation in the pathogenesis of overactive bladder syndrome refractory to antimuscarinic therapy. PLoS ONE 2013; 8: e76706.
10.1371/journal.pone.0076706
CAS PubMed Web of Science® Google Scholar
87Sakakibara R, Uchida Y, Ishii K et al. Bladder recovery relates with increased mid-cingulate perfusion after shunt surgery in idiopathic normal-pressure hydrocephalus: a single-photon emission tomography study. Int. Urol. Nephrol. 2016; 48: 169–74.
10.1007/s11255-015-1162-2
PubMed Web of Science® Google Scholar
88Oh DG, Cho DS, Yun IS, Lee KB, Choi JB, Lee JH. The difference of lower urinary tract symptoms between sympathetic hyperactive and hypoactive men. Int. Neurourol. J. 2013; 17: 30–3.
10.5213/inj.2013.17.1.30
PubMed Web of Science® Google Scholar
89Yokoyama O, Nishizawa O, Homma Y et al. Nocturnal polyuria and hypertension in patients with lifestyle related diseases and overactive bladder. J. Urol. 2017; 197: 423–31.
10.1016/j.juro.2016.08.087
PubMed Web of Science® Google Scholar
90Fujimura T, Yamada Y, Sugihara T et al. Nocturia in men is a chaotic condition dominated by nocturnal polyuria. Int. J. Urol. 2015; 22: 496–501.
10.1111/iju.12710
PubMed Web of Science® Google Scholar
91Fujimura T, Kume H, Nishimatsu H et al. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score. BJU Int. 2012; 109: 1512–6.
10.1111/j.1464-410X.2011.10445.x
PubMed Web of Science® Google Scholar
92Gotoh M, Homma Y, Yokoyama O, Nishizawa O. Responsiveness and minimal clinically important change in overactive bladder symptom score. Urology 2011; 78: 768–73.
10.1016/j.urology.2011.06.020
PubMed Web of Science® Google Scholar
93Alcaraz A, Carballido-Rodriguez J, Unda-Urzaiz M et al. Quality of life in patients with lower urinary tract symptoms associated with BPH: change over time in real-life practice according to treatment–the QUALIPROST study. Int. Urol. Nephrol. 2016; 48: 645–56.
10.1007/s11255-015-1206-7
PubMed Web of Science® Google Scholar
94Choo MS, Han JH, Shin TY et al. Alcohol, smoking, physical activity, protein, and lower urinary tract symptoms: Prospective Longitudinal Cohort. Int. Neurourol. J. 2015; 19: 197–206.
10.5213/inj.2015.19.3.197
PubMed Web of Science® Google Scholar
95Johnson TM 2nd, Markland AD, Goode PS et al. Efficacy of adding behavioural treatment or antimuscarinic drug therapy to alpha-blocker therapy in men with nocturia. BJU Int. 2013; 112: 100–8.
10.1111/j.1464-410X.2012.11736.x
CAS PubMed Web of Science® Google Scholar
96Fernandez RA, Garcia-Hermoso A, Solera-Martinez M, Correa MT, Morales AF, Martinez-Vizcaino V. Improvement of continence rate with pelvic floor muscle training post-prostatectomy: a meta-analysis of randomized controlled trials. Urol. Int. 2015; 94: 125–32.
10.1159/000368618
PubMed Web of Science® Google Scholar
97Yamanishi T, Kaga K, Fuse M, Shibata C, Uchiyama T. Neuromodulation for the treatment of lower urinary tract symptoms. Low. Urin. Tract Symptoms 2015; 7: 121–32.
10.1111/luts.12087
CAS PubMed Web of Science® Google Scholar
98Masumori N, Tsukamoto T, Horita H et al. alpha1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study. Int. J. Urol. 2013; 20: 421–8.
10.1111/j.1442-2042.2012.03165.x
CAS PubMed Web of Science® Google Scholar
99Shigemura K, Yamamichi F, Matsumoto M et al. Comparison of naftopidil 75 mg with tamsulosin hydrochloride 0.2 mg in the treatment of lower urinary tract symptoms with benign prostatic hyperplasia. Low. Urin. Tract Symptoms 2012; 4: 136–9.
10.1111/j.1757-5672.2012.00149.x
CAS PubMed Web of Science® Google Scholar
100Tanaka T, Kuratsukuri K, Yoshimura R et al. Efficacy of naftopidil for nocturia in male patients with lower urinary tract symptoms: comparison of morning and evening dosing. Int. J. Urol. 2015; 22: 317–21.
10.1111/iju.12669
CAS PubMed Web of Science® Google Scholar
101Novara G, Chapple CR, Montorsi F. A pooled analysis of individual patient data from registrational trials of silodosin in the treatment of non-neurogenic male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). BJU Int. 2014; 114: 427–33.
10.1111/bju.12712
PubMed Web of Science® Google Scholar
102Yokoyama T, Hara R, Fujii T, Jo Y, Miyaji Y, Nagai A. Comparison of two different alpha1-adrenoceptor antagonists, tamsulosin and silodosin, in the treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a prospective randomized crossover study. Low. Urin. Tract Symptoms 2012; 4: 14–8.
10.1111/j.1757-5672.2011.00099.x
CAS PubMed Web of Science® Google Scholar
103Shirakawa T, Haraguchi T, Shigemura K et al. Silodosin versus naftopidil in Japanese patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized multicenter study. Int. J. Urol. 2013; 20: 903–10.
10.1111/iju.12055
CAS PubMed Web of Science® Google Scholar
104Gacci M, Andersson KE, Chapple C et al. Latest evidence on the use of phosphodiesterase type 5 inhibitors for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur. Urol. 2016; 70: 124–33.
10.1016/j.eururo.2015.12.048
CAS PubMed Web of Science® Google Scholar
105Chapple CR, Roehrborn CG, McVary K, Ilo D, Henneges C, Viktrup L. Effect of tadalafil on male lower urinary tract symptoms: an integrated analysis of storage and voiding international prostate symptom subscores from four randomised controlled trials. Eur. Urol. 2015; 67: 114–22.
10.1016/j.eururo.2014.08.072
CAS PubMed Web of Science® Google Scholar
106Oelke M, Giuliano F, Baygani SK, Melby T, Sontag A. Treatment satisfaction with tadalafil or tamsulosin vs placebo in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH): results from a randomised, placebo-controlled study. BJU Int. 2014; 114: 568–75.
10.1111/bju.12733
CAS PubMed Web of Science® Google Scholar
107Roehrborn CG, Chapple C, Oelke M, Cox D, Esler A, Viktrup L. Effects of tadalafil once daily on maximum urinary flow rate in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J. Urol. 2014; 191: 1045–50.
10.1016/j.juro.2013.10.074
CAS PubMed Web of Science® Google Scholar
108Dmochowski R, Roehrborn C, Klise S, Xu L, Kaminetsky J, Kraus S. Urodynamic effects of once daily tadalafil in men with lower urinary tract symptoms secondary to clinical benign prostatic hyperplasia: a randomized, placebo controlled 12-week clinical trial. J. Urol. 2013; 189: S135–40.
10.1016/j.juro.2012.11.025
CAS PubMed Web of Science® Google Scholar
109Nishizawa O, Yoshida M, Takeda M et al. Tadalafil 5 mg once daily for the treatment of Asian men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: analyses of data pooled from three randomized, double-blind, placebo-controlled studies. Int. J. Urol. 2015; 22: 378–84.
10.1111/iju.12699
CAS PubMed Web of Science® Google Scholar
110Takeda M, Yokoyama O, Lee SW, Murakami M, Morisaki Y, Viktrup L. Tadalafil 5 mg once-daily therapy for men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results from a randomized, double-blind, placebo-controlled trial carried out in Japan and Korea. Int. J. Urol. 2014; 21: 670–5.
10.1111/iju.12410
CAS PubMed Web of Science® Google Scholar
111Vlachopoulos C, Oelke M, Maggi M et al. Impact of cardiovascular risk factors and related comorbid conditions and medical therapy reported at baseline on the treatment response to tadalafil 5 mg once-daily in men with lower urinary tract symptoms associated with benign prostatic hyperplasia: an integrated analysis of four randomised, double-blind, placebo-controlled, clinical trials. Int. J. Clin. Pract. 2015; 69: 1496–507.
10.1111/ijcp.12722
CAS PubMed Web of Science® Google Scholar
112Park T, Choi JY. Efficacy and safety of dutasteride for the treatment of symptomatic benign prostatic hyperplasia (BPH): a systematic review and meta-analysis. World J. Urol. 2014; 32: 1093–105.
10.1007/s00345-014-1258-9
CAS PubMed Web of Science® Google Scholar
113Wu XJ, Zhi Y, Zheng J et al. Dutasteride on benign prostatic hyperplasia: a meta-analysis on randomized clinical trials in 6460 patients. Urology 2014; 83: 539–43.
10.1016/j.urology.2013.10.007
PubMed Web of Science® Google Scholar
114Tsukamoto T, Endo Y, Narita M. Efficacy and safety of dutasteride in Japanese men with benign prostatic hyperplasia. Int. J. Urol. 2009; 16: 745–50.
10.1111/j.1442-2042.2009.02357.x
CAS PubMed Web of Science® Google Scholar
115Fujimoto K, Hirao Y, Ohashi Y et al. The effects of chlormadinone acetate on lower urinary tract symptoms and erectile functions of patients with benign prostatic hyperplasia: a prospective multicenter clinical study. Adv. Urol. 2013; 2013: 584678.
10.1155/2013/584678
PubMed Google Scholar
116Abraham N, Goldman HB. An update on the pharmacotherapy for lower urinary tract dysfunction. Expert Opin. Pharmacother. 2015; 16: 79–93.
10.1517/14656566.2015.977253
CAS PubMed Web of Science® Google Scholar
117Minagawa T, Ishizuka O. Status of urological Kampo medicine: a narrative review and future vision. Int. J. Urol. 2015; 22: 254–63.
10.1111/iju.12685
CAS PubMed Web of Science® Google Scholar
118Kaplan SA, Roehrborn CG, Abrams P, Chapple CR, Bavendam T, Guan Z. Antimuscarinics for treatment of storage lower urinary tract symptoms in men: a systematic review. Int. J. Clin. Pract. 2011; 65: 487–507.
10.1111/j.1742-1241.2010.02611.x
CAS PubMed Web of Science® Google Scholar
119Yamaguchi O, Marui E, Kakizaki H et al. Phase III, randomised, double-blind, placebo-controlled study of the beta3-adrenoceptor agonist mirabegron, 50 mg once daily, in Japanese patients with overactive bladder. BJU Int. 2014; 113: 951–60.
10.1111/bju.12649
CAS PubMed Web of Science® Google Scholar
120Nitti VW, Auerbach S, Martin N, Calhoun A, Lee M, Herschorn S. Results of a randomized phase III trial of mirabegron in patients with overactive bladder. J. Urol. 2013; 189: 1388–95.
10.1016/j.juro.2012.10.017
CAS PubMed Web of Science® Google Scholar
121Otsuki H, Kosaka T, Nakamura K, Mishima J, Kuwahara Y, Tsukamoto T. beta3-Adrenoceptor agonist mirabegron is effective for overactive bladder that is unresponsive to antimuscarinic treatment or is related to benign prostatic hyperplasia in men. Int. Urol. Nephrol. 2013; 45: 53–60.
10.1007/s11255-012-0343-5
CAS PubMed Web of Science® Google Scholar
122Kuo HC, Lee KS, Na Y et al. Results of a randomized, double-blind, parallel-group, placebo- and active-controlled, multicenter study of mirabegron, a beta3-adrenoceptor agonist, in patients with overactive bladder in Asia. Neurourol. Urodyn. 2015; 34: 685–92.
10.1002/nau.22645
CAS PubMed Web of Science® Google Scholar
123Chapple C, Khullar V, Nitti VW et al. Efficacy of the beta3-adrenoceptor agonist mirabegron for the treatment of overactive bladder by severity of incontinence at baseline: a post hoc analysis of pooled data from three randomised phase 3 trials. Eur. Urol. 2015; 67: 11–4.
10.1016/j.eururo.2014.06.052
CAS PubMed Web of Science® Google Scholar
124Khullar V, Amarenco G, Angulo JC et al. Efficacy and tolerability of mirabegron, a beta(3)-adrenoceptor agonist, in patients with overactive bladder: results from a randomised European-Australian phase 3 trial. Eur. Urol. 2013; 63: 283–95.
10.1016/j.eururo.2012.10.016
CAS PubMed Web of Science® Google Scholar
125Nitti VW, Rosenberg S, Mitcheson DH, He W, Fakhoury A, Martin NE. Urodynamics and safety of the beta(3)-adrenoceptor agonist mirabegron in males with lower urinary tract symptoms and bladder outlet obstruction. J. Urol. 2013; 190: 1320–7.
10.1016/j.juro.2013.05.062
CAS PubMed Web of Science® Google Scholar
126Chung DE, Te AE, Staskin DR, Kaplan SA. Efficacy and safety of tolterodine extended release and dutasteride in male overactive bladder patients with prostates >30 grams. Urology 2010; 75: 1144–8.
10.1016/j.urology.2009.12.010
PubMed Web of Science® Google Scholar
127Maeda T, Kikuchi E, Hasegawa M et al. Solifenacin or mirabegron could improve persistent overactive bladder symptoms after dutasteride treatment in patients with benign prostatic hyperplasia. Urology 2015; 85: 1151–5.
10.1016/j.urology.2015.01.028
PubMed Web of Science® Google Scholar
128Li M, Qiu J, Hou Q et al. Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS ONE 2015; 10: e0121265.
10.1371/journal.pone.0121265
PubMed Web of Science® Google Scholar
129Lucca I, Shariat SF, Hofbauer SL, Klatte T. Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis. World J. Urol. 2015; 33: 563–70.
10.1007/s00345-014-1324-3
PubMed Web of Science® Google Scholar
130Asimakopoulos AD, Mugnier C, Hoepffner JL et al. The surgical treatment of a large prostatic adenoma: the laparoscopic approach–a systematic review. J. Endourol. 2012; 26: 960–7.
10.1089/end.2012.0055
PubMed Web of Science® Google Scholar
131Ferretti M, Phillips J. Prostatectomy for benign prostate disease: open, laparoscopic and robotic techniques. Can. J. Urol. 2015; 22 (Suppl 1): 60–6.
PubMed Google Scholar
132Autorino R, Zargar H, Mariano MB et al. Perioperative outcomes of robotic and laparoscopic simple prostatectomy: a european-american multi-institutional analysis. Eur. Urol. 2015; 68: 86–94.
10.1016/j.eururo.2014.11.044
PubMed Web of Science® Google Scholar
133Ahyai SA, Gilling P, Kaplan SA et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur. Urol. 2010; 58: 384–97.
10.1016/j.eururo.2010.06.005
PubMed Web of Science® Google Scholar
134Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: time for a bespoke approach? Int. J. Urol. 2016; 23: 22–35.
10.1111/iju.12866
PubMed Web of Science® Google Scholar
135Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T. The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU Int. 2010; 105: 1429–33.
10.1111/j.1464-410X.2009.08978.x
CAS PubMed Web of Science® Google Scholar
136Komura K, Inamoto T, Takai T et al. Could transurethral resection of the prostate using the TURis system take over conventional monopolar transurethral resection of the prostate? A randomized controlled trial and midterm results. Urology 2014; 84: 405–11.
10.1016/j.urology.2014.04.025
PubMed Web of Science® Google Scholar
137Skolarikos A, Rassweiler J, de la Rosette JJ et al. Safety and efficacy of bipolar versus monopolar transurethral resection of the prostate in patients with large prostates or severe lower urinary tract symptoms: post hoc analysis of a european multicenter randomized controlled trial. J. Urol. 2016; 195: 677–84.
10.1016/j.juro.2015.08.083
PubMed Web of Science® Google Scholar
138Lourenco T, Shaw M, Fraser C, MacLennan G, N'Dow J, Pickard R. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J. Urol. 2010; 28: 23–32.
10.1007/s00345-009-0496-8
PubMed Web of Science® Google Scholar
139Taylor BL, Jaffe WI. Electrosurgical transurethral resection of the prostate and transurethral incision of the prostate (monopolar techniques). Can. J. Urol 2015; 22 (Suppl 1): 24–9.
PubMed Google Scholar
140Kan CF, Tsu HL, Chiu Y, To HC, Sze B, Chan SW. A prospective study comparing bipolar endoscopic enucleation of prostate with bipolar transurethral resection in saline for management of symptomatic benign prostate enlargement larger than 70 g in a matched cohort. Int. Urol. Nephrol. 2014; 46: 511–7.
10.1007/s11255-013-0546-4
PubMed Web of Science® Google Scholar
141Geavlete B, Bulai C, Ene C, Checherita I, Geavlete P. Bipolar vaporization, resection, and enucleation versus open prostatectomy: optimal treatment alternatives in large prostate cases? J. Endourol. 2015; 29: 323–31.
10.1089/end.2014.0493
PubMed Web of Science® Google Scholar
142Zhu L, Chen S, Yang S et al. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70 ml: a prospective, randomized trial with 5-year followup. J. Urol. 2013; 189: 1427–31.
10.1016/j.juro.2012.10.117
PubMed Web of Science® Google Scholar
143Li S, Zeng XT, Ruan XL et al. Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis. PLoS ONE 2014; 9: e101615.
10.1371/journal.pone.0101615
PubMed Web of Science® Google Scholar
144Yin L, Teng J, Huang CJ, Zhang X, Xu D. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J. Endourol. 2013; 27: 604–11.
10.1089/end.2012.0505
PubMed Web of Science® Google Scholar
145Cornu JN, Ahyai S, Bachmann A et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur. Urol. 2015; 67: 1066–96.
10.1016/j.eururo.2014.06.017
PubMed Web of Science® Google Scholar
146Thomas JA, Tubaro A, Barber N et al. A multicenter randomized noninferiority trial comparing greenlight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur. Urol. 2016; 69: 94–102.
10.1016/j.eururo.2015.07.054
PubMed Web of Science® Google Scholar
147Kim KS, Choi JB, Bae WJ et al. Comparison of photoselective vaporization versus holmium laser enucleation for treatment of benign prostate hyperplasia in a small prostate volume. PLoS ONE 2016; 11: e0156133.
10.1371/journal.pone.0156133
PubMed Web of Science® Google Scholar
148Thangasamy IA, Chalasani V, Bachmann A, Woo HH. Photoselective vaporisation of the prostate using 80-W and 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis from 2002 to 2012. Eur. Urol. 2012; 62: 315–23.
10.1016/j.eururo.2012.04.051
PubMed Web of Science® Google Scholar
149Razzaghi MR, Mazloomfard MM, Mokhtarpour H, Moeini A. Diode laser (980 nm) vaporization in comparison with transurethral resection of the prostate for benign prostatic hyperplasia: randomized clinical trial with 2-year follow-up. Urology 2014; 84: 526–32.
10.1016/j.urology.2014.05.027
PubMed Web of Science® Google Scholar
150Chiang PH, Chen CH, Kang CH, Chuang YC. GreenLight HPS laser 120-W versus diode laser 200-W vaporization of the prostate: comparative clinical experience. Lasers Surg. Med. 2010; 42: 624–9.
10.1002/lsm.20940
CAS PubMed Web of Science® Google Scholar
151Cui D, Sun F, Zhuo J et al. A randomized trial comparing thulium laser resection to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: four-year follow-up results. World J. Urol. 2014; 32: 683–9.
10.1007/s00345-013-1103-6
PubMed Web of Science® Google Scholar
152Peng B, Wang GC, Zheng JH et al. A comparative study of thulium laser resection of the prostate and bipolar transurethral plasmakinetic prostatectomy for treating benign prostatic hyperplasia. BJU Int. 2013; 111: 633–7.
10.1111/j.1464-410X.2012.11610.x
PubMed Web of Science® Google Scholar
153Yang Z, Wang X, Liu T. Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology 2013; 81: 396–400.
10.1016/j.urology.2012.08.069
PubMed Web of Science® Google Scholar
154Zhang F, Shao Q, Herrmann TR, Tian Y, Zhang Y. Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center. Urology 2012; 79: 869–74.
10.1016/j.urology.2011.12.018
PubMed Web of Science® Google Scholar
155Bozkurt IH, Yalcinkaya F, Sertcelik MN, Zengin K, Ekici M, Yigitbasi O. A good alternative to indwelling catheter owing to benign prostate hyperplasia in elderly: memotherm prostatic stent. Urology 2013; 82: 1004–7.
10.1016/j.urology.2013.07.004
PubMed Web of Science® Google Scholar
156Kimata R, Nemoto K, Tomita Y, Takahashi R, Hamasaki T, Kondo Y. Efficacy of a thermoexpandable metallic prostate stent (Memokath) in elderly patients with urethral obstruction requiring long-term management with urethral Foley catheters. Geriatr. Gerontol. Int. 2015; 15: 553–8.
10.1111/ggi.12309
PubMed Web of Science® Google Scholar
157Perera M, Roberts MJ, Doi SA, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur. Urol. 2015; 67: 704–13.
10.1016/j.eururo.2014.10.031
PubMed Web of Science® Google Scholar
158Sonksen J, Barber NJ, Speakman MJ et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur. Urol. 2015; 68: 643–52.
10.1016/j.eururo.2015.04.024
PubMed Web of Science® Google Scholar
159Roehrborn CG, Rukstalis DB, Barkin J et al. Three year results of the prostatic urethral L.I.F.T. study. Can. J. Urol. 2015; 22: 7772–82.
PubMed Web of Science® Google Scholar
160McVary KT, Gange SN, Gittelman MC et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J. Urol. 2016; 195: 1529–38.
10.1016/j.juro.2015.10.181
PubMed Web of Science® Google Scholar
161Shim SR, Kanhai KJ, Ko YM, Kim JH. Efficacy and safety of prostatic arterial embolization: systematic review with meta-analysis and meta-regression. J. Urol. 2017; 197: 465–79.
10.1016/j.juro.2016.08.100
PubMed Web of Science® Google Scholar
162Igawa Y, Wyndaele JJ, Nishizawa O. Catheterization: possible complications and their prevention and treatment. Int. J. Urol. 2008; 15: 481–5.
10.1111/j.1442-2042.2008.02075.x
CAS PubMed Web of Science® Google Scholar
163Akman T, Binbay M, Tekinarslan E et al. Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study. BJU Int. 2013; 111: 129–36.
10.1111/j.1464-410X.2012.11266.x
PubMed Web of Science® Google Scholar
164Gacci M, Ficarra V, Sebastianelli A et al. Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J. Sex. Med. 2014; 11: 1554–66.
10.1111/jsm.12525
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume24, Issue10

October 2017

Pages 716-729

This article also appears in:

Guideline series for IJU