The Modern View of Conservative Therapy of Lower Urinary Tract Symptoms in Men

D.V. Ergakov, A.G. Martov

Department of Minimally Invasive Urology, City Clinical Hospital № 57, Moscow HCD; Department of Urology, Federal Medical Biological Agency
This literature review summarizes recent evidence on monotherapy and combined treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Particular attention is given to the latest publications on this topic presented at the 30th Congress of the European Association of Urology. α-blockers, 5α-reductase inhibitors, anticholinergics and phosphodiesterase type 5 inhibitors are the main classes of medications for monotherapy. Combination therapy of the above medications is the most promising part of this trend in urology allowing increase the effectiveness of treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. A personalized approach to therapy involves a thorough examination of the patient and the administration of treatment according to his individual needs.


1. Oelke M., Bachmann A., Descazeaud A., Emberton M., Gravas S., Michel M.C., N'dow J., Nordling J., de la Rosette J.J.. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur. Urol. 2013;64(1):118–140.

2. Chapple C.R., Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur. Urol. 2006;49(4):651–658.

3. Sexton C.C., Coyne K.S., Kopp Z.S., Irwin D.E., Milsom I., Aiyer L.P., Tubaro A., Chapple C.R., Wein A.J. The overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK and Sweden: EpiLUTS. BJU Int. 2009;103(3):12–23.

4. Irwin D.E., Milsom I., Hunskaar S., Reilly K., Kopp Z., Herschorn S., Coyne K., Kelleher C., Hampel C., Artibani W., Abrams P. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur. Urol. 2006;50(6):1306–1314; discussion 1314–1315.

5. Chapple C.R., Wein A.J., Abrams P., Dmochowski R.R., Giuliano F., Kaplan S.A., McVary K.T., Roehrborn C.G. Lower urinary tract symptoms revisited: a broader clinical perspective. Eur. Urol. 2008;54(3):563–569.

6. Silva J, Silva CM, Cruz F. Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard? Curr Opin Urol. 2014;24(1):21–28.

7. Pirozzi L., Sountoulides P., Pietro C., Presicce F., Lombardo R., Romero M., De Nunzio C., Tubaro A., Schips L., Cindolo L. Current pharmacological treatment for male LUTS due to BPH: dutasteride or finasteride? Curr. Drug. Targets. 2015;17.

8. Pande S., Hazra A., Kundu A.K. Evaluation of silodosin in comparison to tamsulosin in benign prostatic hyperplasia: a randomized controlled trial. Indian J. Pharmacol. 2014;46(6):601–607.

9. Osman N.I., Chapple C.R., Tammela T.L., Eisenhardt A., Oelke M. Open-label, 9-month extension study investigating the uro-selective alpha-blocker silodosin in men with LUTS associated with BPH. World J. Urol. 2015;33(5):697–706.

10. Descazeaud A., de La Taille A., Giuliano F., Desgrandchamps F., Doridot G. Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Prog. Urol. 2015;25(3):115–127.

11. Kim B.S., Kim T-H., Ko Y.H. Prostatic urethral length as a predicting factor for medical treatment failure of benign prostatic hyperplasia: Prospective, multi-center study. Eur. Urol. Suppl. 2015;14/2; e361.

12. Perugia C., Miano R., Topazio L. Intravesical prostatic protrusion influences the efficacy of alpha-blockers in men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). Eur. Urol. Suppl. 2015;14/2; e680.

13. El Harrech E.H.Y., Abaka N., Jihad E.A. Impact of intravesical protrusion of the prostate in the response to alpha-blocker as a treatment for benign prostatic hyperplasia. Eur. Urol. Suppl. 2015;14/2;e681.

14. Radomski S.B. Update on medical therapy for male LUTS. Can Urol. Assoc. J. 2014;8(7–8 Suppl. 5):S148–150.

15. Ken-ichi M., Mizoguchi S., Sumino Y., Sato F. Effects of dutasteride on bone mineral density and hematogenesis in patients with benign prostatic hyperplasia. Eur. Urol. Suppl. 2015;14/2;e687.

16. Zhu Y.P., Dai B., Zhang H.L., Shi G.H., Ye D.W. Impact of preoperative 5α-reductase inhibitors on perioperative blood loss in patients with benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. BMC Urol. 2015;15(1):47.

17. Busetto G.M., Giovannone R., Antonini G., Rossi A., Del Giudice F., Tricarico S., Ragonesi G., Gentile V., De Berardinis E. Short-term pretreatment with a dual 5α-reductase inhibitor before bipolar transurethral resection of the prostate (B-TURP): Evaluation of prostate vascularity and decreased surgical blood loss in large prostate. Eur. Urol. Suppl. 2015;14/2;e678.

18. Margel D., Nandy I., Wilson T.H., Castro R., Fleshner N. Predictors of pathological progression among men with localized prostate cancer undergoing active surveillance: a sub-analysis of the REDEEM study. J. Urol. 2013;190(6):2039–2045.

19. Sakalis V., Sfiggas V., Vouros I. Is there an effect of antimuscarinics on the prostate? Preliminary results from a randomized study in patients with benign prostate enlargement (BPE) and overactive bladder (OAB). Eur. Urol. Suppl. 2015;14/2;e686.

20. Park K.K., Lee S.H., Chung B.H., Kim S.J., Kwak C., Son H.C., Kim S.W., Lee J.Y. Efficacy and safety of low-dose anticholinergics to treat men with lower urinary tract symptoms with overactive bladder: a retrospective study based on real life practice. Prostate Int. 2013;1(1):37–41.

21. Huang EY-H., Lin C-C, Chung H-J. et al. Urinary retention following antimuscarinics in patients with BPH in real life practice – a nation-wide database study. American Urological Association Annual Meeting; San Diego, CA; May 4–8, 2013. Abstr 1386.

22. Lin A.T.L., Huang E.Y-H., Lin C.-C. et al. The association between the duration of antimuscarinics use and urinary retention in patients with BPH-A nation-wide database study. American Urological Association Annual Meeting; San Diego, CA; May 4–8, 2013. Abstr 1388.

23. Nickel J.C., Méndez-Probst C.E., Whelan T.F., Paterson R.F., Razvi H. 2010 Update: Guidelines for the management of benign prostatic hyperplasia. Can Urol. Assoc. J. 2010;4:310–316.

24. Nitti V.W., Rosenberg S., Mitcheson D.H., He W., Fakhoury A., Martin N.E. Urodynamics and safety of the β-adrenoceptor agonist mirabegron in males with lower urinary tract symptoms and bladder outlet obstruction. J. Urol. 2013;190:1320–1327.

25. Weiss J.P., Herschorn S., Albei C.D., van der Meulen E.A. Efficacy and safety of low dose desmopressin orally disintegrating tablet in men with nocturia: Results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J. Urol. 2013;190:965–972.

26. McVary K.T., Kaufman J., Young J.M., Tseng L.J. Sildenafil citrate improves erectile function: A randomised doubleblind trial with open-label extension. Int. J. Clin. Pract. 2007;61:1843–1849.

27. Brock G., Broderick G., Roehrborn C.G., 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;112:990–997.

28. Sakr A.M.N., Fawzi A.M., Youssef M.K. Sildenafil in combination with tamsulosin versus tamsulosin monotherapy for management of male lower urinary tract symptoms due to benign prostatic hyperplasia: A randomized, double-blind trial. Eur. Urol. Suppl. 2015;14/2;e683.

29. Аляев Ю.Г., Винаров А.З., Демидко Ю.Л., Спивак Л.Г. 10-летнее исследование по оценке эффективности и безопасности экстракта Serenoa repens у пациентов с риском прогрессии доброкачественной гиперплазии простаты. Урология. 2013;4:32–36.

30. Füllhase C., Chapple C., Cornu J.N., De Nunzio C., Gratzke C., Kaplan S.A., Marberger M., Montorsi F., Novara G., Oelke M., Porst H., Roehrborn C., Stief C., McVary K.T. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur. Urol. 2013;64(2):228–243.

31. Roehrborn C.G., Barkin J., Tubaro A., Emberton M., Wilson T.H., Brotherton B.J., Castro R. 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(4):623–635.

32. Kaplan S.A., Lee J.Y., Meehan A.G., Kusek J.W. Long-term treatment with finasteride improves clinical progression of benign prostatic hyperplasia in men with an enlarged versus a smaller prostate: data from the MTOPS trial. J. Urol. 2011;185(4):1369–1373.

33. Roehrborn C.G., Oyarzabal Perez, Roos E.P., Calomfirescu N., Brotherton B., Wang F., Palacios J.M., Vasylyev A., Manyak M.J. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results. BJU Int. 2015;7.

34. De Nunzio C., Esperto F., Presicce F. et al. Detrusor wall tickness effect of dutasteride add-on therapy to alpha-adrenergic antagonist for patients with benign prostatic enlargement: A single centre prospective study. Eur. Urol. Suppl. 2015;14/2;e271.

35. Barkin J., Guimarães M., Jacobi G., Pushkar D., Taylor S., van Vierssen Trip O.B. 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(4):461–466.

36. Nickel J.C., Barkin J., Koch C., Dupont C., Elhilali M. Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers. Can. Urol. Assoc. J. 2008;2(1):16–21.

37. Lacy J.M., Kyprianou N. A tale of two trials: The impact of 5α-reductase inhibition on prostate cancer. Oncol. Lett. 2014;8(4):1391–1396.

38. Kaplan S.A., Roehrborn C.G., Abrams P., Chapple C.R., Bavendam T., Guan Z. Antimuscarinics for treatment of storage lower urinary tract symptoms in men: a systematic review. Int. J. Clin. Pract. 2011;65(4):487–507.

39. Tuncel A., Nalcacioglu V., Ener K., Aslan Y., Aydin O., Atan A. Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. World J. Urol. 2010;28:17–22.

40. Elkelany O.O., Owen R.C., Kim E.D. Combination of tadalafil and finasteride for improving the symptoms of benign prostatic hyperplasia: critical appraisal and patient focus. Ther. Clin. Risk Manag. 2015;11:507–513.

41. Roehrborn C.G., Casabé 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(6):582–587.

42. Chung D.E., Te A.E., Staskin D.R., Kaplan S.A. Efficacy and safety of tolterodine extended release and dutasteride in male overactive bladder patients with prostates >30 grams. Urology. 2010;75(5):1144–1148.

About the Autors

Correspondence author: D.V. Ergakov – M.D., Physician at Department of Minimally Invasive Urology,
City Clinical Hospital № 57; e-mail:

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