The evolving picture of lower urinary tract symptom management

The management of lower urinary tract symptoms (LUTS) in men has often been associated with benign prostatic obstruction and managed accordingly. In the last three decades, pharmacologic treatment of LUTS became the standard approach to men bothered by voiding and storage symptoms, leaving surgery as a second-line option. Better understanding of LUTS pathophysiology broadened understanding of a number of mechanisms involved in the genesis of LUTS, including occult neurogenic disorders; hormonal and vascular changes associated with ageing, diabetes, obesity, and other conditions leading to metabolic syndrome; and bladder and urothelial disorders. The composite pathophysiology of male LUTS has not yet fully translated to a more sophisticated therapeutic approach, although a number of properly designed randomised trials are helping refine our therapeutic strategy. The clear success of the medical treatment of male LUTS helped change the treatment management of male LUTS, with a large decrease in surgical procedures in favour of widespread use of medications [1]. The number of treated patients has continued to increase in recent years [1]. Notwithstanding the clear success of the medical treatment of male LUTS, real-life data highlight a number of unmet needs, as some of the patients remain bothered and symptomatic despite treatment. Current medical options include (in order of introduction in the formularies) phytotherapeutic agents, α-blockers, 5α-reductase inhibitors (5-ARIs), antimuscarinics, phosphodiesterase type 5 inhibitors, and β3 agonists.