Detrusor-Directed Therapy in Men With Benign Prostatic Hyperplasia

As men age, the incidence of benign prostatic hyperplasia and bothersome lower urinary tract symptoms increases. Until recently, treatment modalities focused on prostatic-directed management, but there has been a shift in focus as emerging research has implicated the bladder as a significant player in the development of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Although initially avoided in this population, recent studies have demonstrated the safety and efficacy of antimuscarinics. Epidemiologic studies illustrating the link between erectile dysfunction and lower urinary tract symptoms then led to the investigation of phosphodiesterase-5 inhibitors for symptom management. Novel agents, including β₃ adrenoreceptor agonists, are now being introduced in trials. These agents may offer the efficacy of an anticholinergic without the associated side effects. As future research develops, we are sure to see the introduction of a host of novel agents in the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia.