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Context The treatment of nocturia is a key challenge due to the multi-factorial pathophysiology of the symptom and the disparate outcome measures used in research. Objective To assess and compare available therapy options for nocturia, in terms of symptom severity and quality of life. Evidence acquisition Medical databases (Embase, Medline, Cochrane Systematic Reviews, Cochrane Central) were searched with no date restriction. Comparative studies were included which studied adult men with nocturia as the primary presentation and lower urinary tract symptoms including nocturia or nocturnal polyuria. Outcomes were symptom severity, quality of life, and harms. Evidence synthesis We identified 44 articles. Antidiuretic therapy using dose titration was more effective than placebo in relation to nocturnal voiding frequency and duration of undisturbed sleep; baseline serum sodium is a key selection criterion. Screening for hyponatremia (< 130 mmol/l) must be undertaken at baseline, after initiation or dose titration, and during treatment. Medications to treat lower urinary tract dysfunction (α-1 adrenergic antagonists, 5-α reductase inhibitors, phosphodiesterase type 5inhibitor, antimuscarinics, beta-3 agonist, and phytotherapy) were generally not significantly better than placebo in short-term use. Benefits with combination therapies were not consistently observed. Other medications (diuretics, agents to promote sleep, nonsteroidal anti-inflammatories) were sometimes associated with response or quality of life improvement. The recommendations of the Guideline Panel are presented. Conclusions Issues of trial design make therapy of nocturia a challenging topic. The range of contributory factors relevant in nocturia makes it desirable to identify predictors of response to guide therapy. Consistent responses were reported for titrated antidiuretic therapy. For other therapies, responses were less certain, and potentially of limited clinical benefit. Patient summary This review provides an overview of the current drug treatments of nocturia, which is the need to wake at night to pass urine. The symptom can be caused by several different medical conditions, and measuring its severity and impact varies in separate research studies. No single treatment deals with the symptom in all contexts, and careful assessment is essential to make suitable treatment selection. [ABSTRACT FROM AUTHOR]

Abstract: Context: Several randomized controlled trials (RCTs) on phosphodiesterase type 5 inhibitors (PDE5-Is) have showed significant improvements in both lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men affected by one or both conditions, without a significant increase in adverse events. However, the results are inconsistent. Objective: Perform a systematic review and meta-analysis of available prospective and cross-sectional studies on the use of PDE5-Is alone or in combination with α1-adrenergic blockers in patients with LUTS/benign prostatic hyperplasia (BPH). Evidence acquisition: A systematic search was performed using the Medline, Embase, and Cochrane Library databases through September 2011 including the combination of the following terms: LUTS, BPH, PDE5-Is, sildenafil, tadalafil, vardenafil, udenafil, α-blockers, and α1-adrenergic blocker. The meta-analysis was conducted according to the guidelines for observational studies in epidemiology. Evidence synthesis: Of 107 retrieved articles, 12 were included in the present meta-analysis: 7 on PDE5-Is versus placebo, with 3214 men, and 5 on the combination of PDE5-Is with α1-adrenergic blockers versus α1-adrenergic blockers alone, with 216 men. Median follow-up of all RCTs was 12 wk. Combining the results of those trials, the use of PDE5-Is alone was associated with a significant improvement of the International Index of Erectile Function (IIEF) score (+5.5; p <0.0001) and International Prostate Symptom Score (IPSS) (−2.8; p <0.0001) but not the maximum flow rate (Qmax) (−0.00; p = not significant) at the end of the study as compared with placebo. The association of PDE5-Is and α1-adrenergic blockers improved the IIEF score (+3.6; p <0.0001), IPSS score (−1.8; p = 0.05), and Qmax (+1.5; p <0.0001) at the end of the study as compared with α-blockers alone. Conclusions: The meta-analysis of the available cross-sectional data suggests that PDE5-Is can significantly improve LUTS and erectile function in men with BPH. PDE5-Is seem to be a promising treatment option for patients with LUTS secondary to BPH with or without ED. [Copyright &y& Elsevier]

Abstract: Background: Two potential targets for preventing chronic lower urinary tract symptoms (LUTS) in older men are obesity and physical activity. Objective: To examine associations of adiposity and physical activity with incident LUTS in community-dwelling older men. Design, setting, and participants: The Osteoporotic Fractures in Men Study (MrOS) is a prospective cohort of men ≥65 yr of age. MrOS participants without LUTS and a history of LUTS treatment at baseline were included in this analysis. Measurements: Adiposity was measured with body mass index (BMI), physical activity with the Physical Activity Scale for the Elderly (PASE) and self-report of daily walking, and LUTS with the American Urological Association Symptom Index. Results and limitations: The mean age (standard deviation [SD]) of the 1695 participants was 72 (5) yr at baseline. At a mean (SD) follow-up of 4.6 (0.5) yr, 524 (31%) of men reported incident LUTS. In multivariate analyses, compared with men of normal weight at baseline (BMI <25kg/m2), overweight (BMI: 25.0–29.9kg/m2) and obese (≥30kg/m2)men were 29% (adjusted odds ratio [ORadj]: 1.29; 95% confidence interval [CI], 1.00–1.68) and 41% (ORadj: 1.41; 95% CI, 1.03–1.93) more likely to develop LUTS, respectively. Men in the highest quartile of physical activity were 29% (ORadj: 0.71; 95% CI, 0.53–0.97) and those who walked daily 20% (ORadj: 0.80; 95% CI, 0.65–0.98) less likely than their sedentary peers to develop LUTS, adjusting for BMI. The homogeneous composition of MrOS potentially diminishes the external validity of these results. Conclusions: In older men, obesity and higher physical activity are associated with increased and decreased risks of incident LUTS, respectively. Prevention of chronic urinary symptoms represents another potential health benefit of exercise in elderly men. [Copyright &y& Elsevier]

Abstract: Context: This review focuses on the relationship among sexual dysfunction (SD), lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), and related therapies. Objective: We reviewed the current literature to provide an overview of current data regarding epidemiology and pathophysiology of SD and LUTS. Moreover, we analysed the impact of currently available therapies of LUTS/BPH on both erectile dysfunction (ED) and ejaculatory dysfunction and the effect of phosphodiesterase type 5 inhibitors (PDE5-Is) in patients with ED and LUTS. Evidence acquisition: We conducted a Medline search to identify original articles, reviews, editorials, and international scientific congress abstracts by combining the following terms: benign prostatic hyperplasia, lower urinary tract symptoms, sexual dysfunction, erectile dysfunction, and ejaculatory dysfunction. Evidence synthesis: We conducted a comprehensive analysis of more relevant general population–based and BPH/LUTS or SD clinic-based trials and evaluated the common pathophysiologic mechanisms related to both conditions. In a further step, the overall impact of current BPH/LUTS therapies on sexual life, including phytotherapies, novel drugs, and surgical procedures, was scrutinized. Finally, the usefulness of PDE5-Is in LUTS/BPH was critically analysed, including preclinical and clinical research data as well as possible mechanisms of action that may contribute to the efficacy of PDE5-Is with LUTS/BPH. Conclusions: Community-based and clinical data demonstrate a strong and consistent association between LUTS and ED, suggesting that elderly men with LUTS should be evaluated for SD and vice versa. Pathophysiologic hypotheses regarding common basics of LUTS and SD as discussed in the literature are (1) alteration of the nitric oxide (NO)–cyclic guanosine monophosphate (cGMP) pathway, (2) enhancement of RhoA–Rho-kinase (ROCK) contractile signalling, (3) autonomic adrenergic hyperactivity, and (4) pelvic atherosclerosis. The most important sexual adverse effects of medical therapies are ejaculation disorders after the use of some α-blockers and sexual desire impairment, ED, and ejaculatory disorders after the use of α-reductase inhibitors. Minimally invasive, conventional, and innovative surgical treatments for BPH may induce both retrograde ejaculation and ED. PDE5-Is have demonstrated significant improvements in both LUTS and ED in men with BPH; combination therapy with PDE5-Is and α1-adrenergic blockers seems superior to PDE5-I monotherapy. [Copyright &y& Elsevier]

Abstract: Background: Knowledge of baseline factors that influence outcomes for men with benign prostatic hyperplasia (BPH) receiving medical therapy may help to improve outcomes and cost effectiveness. Objectives: To examine the influence of baseline parameters on changes in International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in men with BPH receiving dutasteride, tamsulosin, or a combination of the two using 2-yr Combination of Avodart and Tamsulosin (CombAT) study data. Design, setting, and participants: CombAT is an ongoing, 4-yr, multicentre, randomised, double-blind study in 4844 men aged ≥50 yr with clinical diagnosis of BPH, IPSS ≥12, prostate volume ≥30cm3, prostate-specific antigen (PSA) 1.5–10ng/ml, and Qmax >5 and ≤15ml/s with minimum voided volume ≥125ml. Intervention: Daily tamsulosin 0.4mg, dutasteride 0.5mg, or the combination. Measurements: Post hoc analyses of mean IPSS and Qmax changes from baseline by treatment group and by baseline prostate volume, PSA, age, body mass index (BMI), IPSS, IPSS quality of life (QoL) score, BPH Impact Index score, Qmax, and previous BPH medical therapy. Results and limitations: Combination therapy was more effective than either monotherapy after 24 mo in improving IPSS in all baseline subgroups, with benefit onset varying by baseline prostate volume. Combination therapy was also more effective in improving Qmax versus tamsulosin in all subgroups and versus dutasteride in 10 of 18 subgroups. At 24 mo, dutasteride monotherapy resulted in significantly greater IPSS improvements versus tamsulosin in men with lower age, worse symptoms, worse QoL, less bother, higher BMI, greater Qmax, higher prostate volume, and higher PSA at baseline. Post hoc analyses, the lack of placebo control, and the exclusion of men with unsuccessful medical BPH treatment are study limitations. Conclusions: Combination therapy with tamsulosin and dutasteride affords the greatest and the most rapid symptomatic benefit among men with higher baseline prostate volume and is effective regardless of previous BPH medical therapy. Dutasteride monotherapy is more effective than tamsulosin in men with higher baseline prostate volume or PSA and worse symptoms. [Copyright &y& Elsevier]

Abstract: Objectives: To determine which factors predict seeking of primary care among men with lower urinary tract symptoms (LUTS). Methods: A longitudinal, population-based study with a follow-up period of 6.5 yr was conducted among 1688 men aged 50–78 yr. The following data were collected: prostate volume (using transrectal ultrasonometry), urinary flow rate, ultrasound-estimated postvoid residual urine volume, generic and disease-specific quality of life (QOL), and symptom severity (International Prostate Symptom Score [IPSS]). Information on the seeking of primary care by all participants during 2 yr of follow-up was collected from the general practitioner''s (GP) record using a computerised search engine and a manual check of electronically selected files. Results: Prostate volume, postvoid residual volume, IPSS, and social generic QOL are important determinants of first GP consultation in men with LUTS. Measurements (physical urologic parameters) and self-reported items (symptom severity and QOL) contribute almost equally to GP consultation in these men. Conclusions: Both measurements of prostate volume and postvoid residual urine volume and self-reported information about symptoms or QOL can help to select those who will benefit from medical care and to reassure those men not likely to need help in the near future. [Copyright &y& Elsevier]

Abstract: Objective:: To determine the IPSS in a selected population reporting no voiding complaints. Subjects and methods:: 1143 adults without voiding complaints were included. They were divided over both sexes and all decades. All subjects filled out questionnaires including the IPSS. Statistical analysis was aimed at relating the IPSS to age and gender. Results:: The IPSS in both sexes shows a gradual significant increase in consecutive age groups. Men in the third age decade have a mean score of 2.8, while men older than 70 years of age have a score of 7.0. In women these scores are 4.0 and 5.6 respectively. The increase is about equally caused by storage and voiding scores. The items addressing weak stream in men and nocturia and urgency in men and women are the major factors causing the correlation with age. Nearly 17% of all subjects have moderate symptom scores and 1% has severe scores. Conclusion:: In both adult men and women reporting no voiding complaints the IPSS increases with age. This rise is more prominent in males. [Copyright &y& Elsevier]

Objective: The aim of this study was to identify the clinical baseline factors that affect the long-term treatment failure of benign prostatic hyperplasia (BPH).Methods: 437 men over 50 years of age with BPH were enrolled for this analysis. Patients were allocated to a medication and a surgical treatment (following medication) group. We initially examined the International Prostatic Symptom Score (IPSS), uroflow rate, prostate volume, postvoid residual volume, and the serum prostate specific antigen level as clinical baseline factors and analyzed differences between the two groups.Results: 337 patients (77.1%) were given maintenance medical treatment during follow-up, and 100 patients (22.9%) had surgical treatment following medication. Statistically significant differences were found in IPSS and prostate volume between the surgical and medication groups (IPSS: 22.6±6.4 vs. 18.7±5.8, prostate volume (cm3): 36.3±14.4 vs. 30.1±11.0, respectively). According to the ROC curve-based prediction of the failure for medical therapy, the best cutoff values of IPSS and prostate volume were 21 (area under ROC curve: 0.67) and 32 cm3 (area under ROC curve: 0.65), respectively.Conclusions: The results show that BPH patients with more severe IPSS and larger prostate volume have a higher risk of medical treatment failure, and suggest that the IPSS and prostate volume may be useful predictors of medical treatment maintenance. [Copyright &y& Elsevier]

Objective: Evaluate the predictive value of a combination of IPSS, uroflowmetry and ultrasound determination of residual urine volume in the determination of bladder outflow obstruction (BOO) and in predicting treatment outcome.Methods: Forty-five out of a group of 60 BPH symptomatic patients were included. Preoperative evaluation: urine culture, PSA, uroflowmetry with sonographic measurement of post-void residual urine, DRE, IPSS with quality of life questions and pressure-flow study. Selection criteria for surgery were IPSS>16 and Qmax<10 ml/s. Transurethral resection of the prostate was performed in these patients; the control visit was performed at 3 months. Treatment success was defined as Qmax above 15 ml/s, residual urine of less than 100 ml, a 50% reduction in IPSS and absence of urinary retention.Results: Urodynamic abnormalities were found in 42 patients (93.3%): 19 had detrusor instability, 5 patients showed impaired contractility, 37 patients had proven BOO, and 8 patients were unobstructed or mildly obstructed. The overall success rate was 86% when measured by the IPSS. Its preoperative value was 16.9, and dropped significantly to 4 (P=0.005). The score improved significantly after surgery only in the obstructed group compared to the non-obstructed group (P=0.001), however preoperative IPSS did not correlate with objective treatment results.Conclusions: A high proportion of patients successfully operated (71.1%) had a combination of IPSS>16 and Qmax<10 ml/s, although BOO could not be accurately predicted with non-invasive methods alone. Patients with no or mild infravesical obstruction had only minimal improvement of IPSS and uroflowmetry following surgery. [ABSTRACT FROM AUTHOR]