What are the causes of urinary hesitancy in males?

From the Guidelines

Urinary hesitancy in males should be managed with a combination of lifestyle modifications and medical treatment, prioritizing alpha-blockers like tamsulosin (Flomax) 0.4mg daily for immediate relief, as recommended by the most recent European Association of Urology guidelines 1. The condition is often caused by an enlarged prostate (benign prostatic hyperplasia or BPH), but can also result from urinary tract infections, medication side effects, neurological conditions, or psychological factors. For immediate relief, try relaxation techniques while urinating, such as running water in the sink, applying warm compresses to the lower abdomen, or sitting down to urinate. Medical treatment typically includes alpha-blockers like tamsulosin (Flomax) 0.4mg daily, which relax prostate and bladder neck muscles to improve urine flow, often working within 2-3 days. 5-alpha reductase inhibitors such as finasteride 5mg daily or dutasteride 0.5mg daily may be prescribed for long-term prostate size reduction, though these take 3-6 months for full effect, as supported by the American Urological Association guidelines 1. Some key points to consider in the management of urinary hesitancy in males include:

• The importance of a careful medical history and physical examination in the assessment of men with LUTS, as emphasized by the European Association of Urology guidelines 1
• The use of validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms, to guide treatment decisions
• The consideration of prostate-specific antigen testing if a diagnosis of prostate cancer would change the treatment plan
• The role of urodynamics in selected patients, and the reservation of surgery for men with absolute indications or those who fail or prefer not to receive medical treatment It's essential to see a doctor promptly for proper diagnosis, especially if hesitancy is accompanied by pain, blood in urine, or complete inability to urinate, as these may indicate more serious conditions requiring immediate attention. Lifestyle modifications like limiting evening fluids, reducing alcohol and caffeine intake, and avoiding medications that worsen symptoms (like decongestants and antihistamines) can also help manage this condition. The European Association of Urology guidelines 1 provide a comprehensive framework for the management of non-neurogenic male lower urinary tract symptoms, emphasizing the importance of a practical assessment, careful medical history, and physical examination, as well as the use of validated symptom scores and other diagnostic tools to guide treatment decisions.

From the FDA Drug Label

Symptoms were quantified using a score similar to the American Urological Association Symptom Score, which evaluated both obstructive symptoms (impairment of size and force of stream, sensation of incomplete bladder emptying, delayed or interrupted urination) and irritative symptoms (nocturia, daytime frequency, need to strain or push the flow of urine) by rating on a 0 to 5 scale for six symptoms and a 0 to 4 scale for one symptom, for a total possible score of 34.

Urinary Hesitancy in Males: Finasteride has been shown to improve symptoms of Benign Prostatic Hyperplasia (BPH), including obstructive symptoms such as:

• Impairment of size and force of stream
• Sensation of incomplete bladder emptying
• Delayed or interrupted urination, which can be related to urinary hesitancy Finasteride tablets decreased the risk of acute urinary retention and the need for BPH-related surgery compared to placebo 2. The improvement in BPH symptoms, including urinary hesitancy, was seen during the first year and maintained throughout an additional 5 years of open extension studies.

From the Research

Urinary Hesitancy in Males

Urinary hesitancy is a common symptom of benign prostatic hyperplasia (BPH) in males. The following points summarize the key aspects of urinary hesitancy in males:

• Urinary hesitancy is a typical presenting symptom of BPH, along with weak stream, nocturia, incontinence, and recurrent urinary tract infections 3.
• The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity, including urinary hesitancy 3, 4.
• Alpha-blockers and 5-alpha-reductase inhibitors are two drug classes used in the medical management of BPH, which can help relieve symptoms of urinary hesitancy 5, 6, 7.
• Alpha-blockers improve symptoms relatively quickly, while 5-alpha-reductase inhibitors have a slower onset of action but may decrease prostate size and alter the disease course 3.
• Surgical therapy, such as transurethral resection of the prostate, is effective and indicated for men with complications from BPH or who fail medical therapy 3, 4.

Treatment Options

The treatment options for urinary hesitancy in males with BPH include:

• Watchful waiting with annual reassessment for men with mild symptoms 3, 4.
• Pharmacologic treatment with alpha-adrenergic blockers and 5-alpha-reductase inhibitors 5, 6, 7, 3, 4.
• Surgical therapy, such as transurethral resection of the prostate or laser-based surgical techniques 3, 4.