What are the medications for Lower Urinary Tract Symptoms (LUTS)?

From the Guidelines

For patients with LUTS associated with demonstrable prostatic enlargement, a combination of 5-ARI and an alpha blocker should be offered as a treatment option. This approach is supported by the American Urological Association (AUA) guideline, which recommends combination therapy for patients with a prostate volume of >30cc on imaging, a PSA >1.5ng/mL, or palpable prostate enlargement on DRE 1. The guideline suggests that this combination can provide statistically significant reductions in parameters of clinical progression over monotherapy.

Some key points to consider when selecting LUTS medications include:

• Alpha blockers, such as tamsulosin or alfuzosin, are first-line treatments that relax smooth muscle in the prostate and bladder neck, providing quick symptom relief.
• 5-alpha reductase inhibitors, such as finasteride or dutasteride, can be added to reduce prostate size over 3-6 months in patients with enlarged prostates.
• Anticholinergic agents, such as oxybutynin or solifenacin, or beta-3 agonists, such as mirabegron, may be offered as treatment options for patients with moderate to severe predominant storage LUTS 1.
• Combination therapy, including alpha blockers + 5-ARI, alpha-blocker + anticholinergic/antimuscarinic therapy, or alpha blockers + beta-3-agonists, can be used to maximize symptom control.

It is essential to note that the combination of low-dose daily 5mg tadalafil with alpha blockers should not be offered for the treatment of LUTS/BPH, as it offers no advantages in symptom improvement over either agent alone 1. Regular follow-up is necessary to assess the effectiveness of treatment and adjust as needed, and lifestyle modifications, such as reducing evening fluid intake and limiting caffeine and alcohol, can enhance medication effectiveness.

From the FDA Drug Label

Mirabegron is an agonist of the human beta-3 adrenergic receptor (AR) as demonstrated by in vitro laboratory experiments using the cloned human beta-3 AR. Mirabegron relaxes the detrusor smooth muscle during the storage phase of the urinary bladder fill-void cycle by activation of beta-3 AR which increases bladder capacity The effects of mirabegron on maximum urinary flow rate and detrusor pressure at maximum flow rate were assessed in a urodynamic study consisting of 200 male patients with lower urinary tract symptoms (LUTS) and BOO

Mirabegron is used to treat lower urinary tract symptoms (LUTS) by relaxing the detrusor smooth muscle and increasing bladder capacity.

• It is a beta-3 adrenergic agonist that works by activating the beta-3 adrenergic receptor.
• The medication has been studied in patients with LUTS and benign prostatic obstruction (BOO), and has been shown to not adversely affect maximum urinary flow rate or detrusor pressure at maximum flow rate 2.

From the Research

LUTS Medication Overview

• LUTS (Lower Urinary Tract Symptoms) can be managed with various medications, including alpha-blockers, 5-alpha-reductase inhibitors, anticholinergics, and phosphodiesterase type 5 inhibitors 3.
• Alpha-blockers, such as tamsulosin, are effective in improving maximal urine flow and alleviating LUTS in patients with benign prostatic hyperplasia (BPH) 4.

Combination Therapy

• Combination therapy with alpha-blockers and 5-alpha-reductase inhibitors has been shown to be effective in reducing BPH-related symptoms and preventing disease progression 5.
• The Medical Therapy of Prostatic Symptoms (MTOPS) study found that combination therapy with doxazosin and finasteride was significantly more effective than either component alone in reducing BPH-related symptoms and lowering the rate of overall clinical progression 5.

Newer Treatment Options

• Silodosin, an alpha-1A specific alpha-blocker, has been shown to be effective in reducing BPH/LUTS with little cardiovascular adverse events 6.
• Mirabegron, a beta-3 adrenoreceptor agonist, has been shown to improve OAB symptoms and patient-reported outcomes in men with LUTS and OAB symptoms 7.
• Tadalafil, a phosphodiesterase type 5 inhibitor, has been shown to improve BPH/LUTS and sexual function in men with BPH 6.

Treatment Considerations

• The choice of medication should take into account individual patient factors, such as symptom severity, prostate size, and presence of comorbidities 3.
• Combination therapy may be beneficial for patients with more severe symptoms or larger prostate size 5.
• The presence of prostatic inflammation may indicate a greater likelihood of treatment efficacy with combination alpha-blocker and 5-alpha-reductase inhibitor therapy 5.