Drug treatments for lower urinary tract symptoms secondary to bladder outflow obstruction: focus on quality of life

Abstract

Benign prostatic hyperplasia (BPH), now referred to as lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO), is a significant cause of morbidity in ageing men. Surgery has virtually eliminated BPH-related mortality, and so the focus for men and their urologist is improvement in urinary symptoms and quality of life. Numerous tools have been developed to quantify symptoms and impact on quality of life--the most commonly used is the International Prostate Symptom Score. Sexual function and the avoidance of BPH-related complications such as acute urinary retention and surgery are also important to men--tools are available to assess sexual function but the benefits of complication avoidance are difficult to quantify. Approximately one million men in the UK have brought their symptoms to the attention of their doctor and been given a diagnosis of BPH, but extrapolation from community based studies suggests that many more (up to 2.5 million men) may have significant symptoms without seeking attention. Histopathological BPH, diminishing peak urinary flow rate, worsening lower urinary tract symptoms and increasing impact on quality of life all become more common as men age. Two groups of drugs are commonly used to treat LUTS/BOO--alpha-adrenoreceptor antagonists and 5alpha-reductase inhibitors. Both groups have been shown to improve quality of life measures in randomised, placebo-controlled trials--usually by approximately twice as much as placebo.