Beyond prostate, beyond surgery and beyond urology: The "3Bs" of managing non-neurogenic male lower urinary tract symptoms

Abstract

Lower urinary tract symptoms (LUTS), consisting storage, voiding and post-micturition symptoms, is a comprehensive definition involving symptoms that may occur due to several causes. Instead of simply focusing on the enlarged prostate, more attention has to be paid to the entire urinary tract as well as multiple system comorbidities. Therefore, prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required. Based on current literature, this paper proposes the "3Bs" concept for managing non-neurogenic male LUTS, namely, "beyond prostate", "beyond surgery" and "beyond urology". The clinical application of the "3Bs" enables urologists to carry out integrated, individualized and precise medical care for each non-neurogenic male LUTS patient.

Keywords: Benign prostatic hyperplasia; Benign prostatic obstruction; Comorbidities; Detrusor overactivity; Detrusor underactivity; Lower urinary tract symptoms; Male; Prostate surgery.

Figure 1

Cartoon depicting the differences among benign prostatic hyperplasia (BPH), benign prostatic enlargement (BPE) and benign prostatic obstruction (BPO). Reproduced from Housami F et al., 2008 .

Figure 2

Common urological causes of male lower urinary tract symptoms. Reproduced, with permission, from EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. Benign Prostatic Obstruction, 2017 .

Figure 3

Schematic illustrated the “3Bs” of managing non-neurogenic male lower urinary tract symptoms, i.e., beyond prostate (A), beyond surgery (B) and beyond urology (C). The bullet points in the right column represent examples of the pointed categories in the circles. 5αRI, 5α-reductase inhibitors; BPK, bladder prostate and kidney; BPO, benign prostatic obstruction; BPH, benign prostatic hyperplasia; CKD, chronic kidney diseases; DO, detrusor overactivity; DU, detrusor underactivity; PDE5I, phosphodiesterase type 5 inhibitors.