Improved treatments provide relief for men with lower urinary tract symptoms

The Bottom Line

  • Lower urinary tract symptoms are common among older men and include needing to urinate often, having pain or difficulty urinating, or getting up frequently at night to urinate.
  • Recent studies show that combination drug treatment – with both alpha-blockers and 5-alpha reductase inhibitors – can offer improved long-term symptom relief for men with lower urinary tract symptoms.
  • If you are experiencing lower urinary tract symptoms, talk to your doctor about your testing and treatment options.

You know what they say: “When you gotta go, you gotta go.” But sometimes it’s not that simple. You either can’t go easily, or have to go too often, or experience pain or difficulty... Whatever form they take, lower urinary tract symptoms in men are worrisome, uncomfortable and can be a red flag for more serious health problems.

It is believed that at any given time, up to 25% of men are affected by urinary issues to some degree or another (1) and as they age, their chances of experiencing and suffering symptoms increase dramatically (2). That’s because lower urinary tract symptoms are often caused by an enlarged prostate, a condition called benign prostatic hyperplasia which typically affects older men (2). Fortunately, research into this common - but frustrating - condition has led to the development of new treatments.

The first line of attack is usually medication with drugs like “Alpha-blockers” which help relax muscles and blood vessels, with trade names like Hytrin®, Uroxatral®, Cardura® and Flomax®, or “5-alpha reductase inhibitors” (or 5-ARIs) like Propecia®, Proscar® and Avodart®), which affect hormones related to the prostate (2). Men are usually prescribed one or the other, but now scientists are wondering if taking both drugs would work better given they manage different symptoms. One recent systematic review of 15 randomized controlled trials explored whether taking these drugs together produced better results than if taken alone (3). Over 9,600 men with lower urinary tract symptoms were included in the studies and the average age was 62 to 66 years. Those in the study group were given a combination of alpha-blockers and 5-ARIs and compared to the control group who were prescribed just one or the other or a placebo.

What the research tells us

The research evidence showed that in the short term (up to a year) combination treatment reduced symptoms more than 5-ARIs alone and about the same as alpha-blockers (3). The long-term effects (two to six years) showed that combination treatment was more effective at reducing symptoms than either drug alone (3). Alpha-blockers can cause side effects such as dizziness and low blood pressure, and may increase the risk of falls, fractures and head injuries as a result (4). 5-ARIs can cause sexual side effects such as decreased libido and erectile dysfunction. Although there were no severe side effects reported in this review, the authors caution that combination drug therapy could increase the number and severity of side effects experienced by patients. 

If you are experiencing lower urinary tract symptoms, talk to your doctor about your treatment options. Ideally you will be able to benefit from the latest developments and get back to feeling (and going!) as good as new.

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  1. Irwin DE, Kopp ZS, Agatep B, et al. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011 Oct;108(7):1132-1138. 
  2. Oelke M, Bachmann A, Descazeaud A, et al. European Association of Eurology guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013 Jul;64(1):118-140. 
  3. Fullhase C, Chapple C, Cormu JN, et al. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur Urol. 2013 Aug;64(2):228-243.
  4. Welk B, McArthur E, Fraser L-A, et al.  The risk of fall and fracture with the initiation of a prostate-selective alpha-agonist: a population based cohort study.  BMJ. 2015; 351:h5398.

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