What are the causes of urinary urgency in males?

From the Guidelines

Urinary urgency in males is best managed through a combination of lifestyle changes and medical treatments, with the most recent guidelines from the European Association of Urology in 2023 providing evidence-based guidance on assessment and treatment. When managing urinary urgency in males, it is essential to consider the patient's quality of life and potential underlying causes, such as benign prostatic hyperplasia, overactive bladder, or neurological conditions affecting bladder control 1. The following lifestyle changes can help alleviate symptoms:

• Reducing fluid intake before bedtime
• Limiting caffeine and alcohol consumption
• Practicing pelvic floor exercises (Kegels) to strengthen bladder control muscles For medication options, the following can be considered:
• Alpha-blockers like tamsulosin (0.4mg daily) or alfuzosin (10mg daily) to relax prostate and bladder neck muscles, improving urine flow
• Anticholinergics such as oxybutynin (5mg twice daily) or solifenacin (5-10mg daily) to reduce bladder muscle contractions that cause urgency
• 5-alpha reductase inhibitors like finasteride (5mg daily) or dutasteride (0.5mg daily) to shrink the prostate over 3-6 months in men with enlarged prostates
• Mirabegron (25-50mg daily), a beta-3 adrenergic agonist, as an alternative for those who can't tolerate anticholinergics It is crucial to note that the European Association of Urology guidelines emphasize the importance of considering patients' values and preferences when making treatment decisions 1. If symptoms persist despite these interventions, or if blood appears in urine, it is essential to seek medical evaluation promptly, as these could indicate more serious conditions requiring different treatment approaches.

From the FDA Drug Label

CLINICAL STUDIES Tolterodine tartrate tablets were evaluated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency in four randomized, double-blind, placebo-controlled, 12-week studies. Oxybutynin chloride relaxes bladder smooth muscle In patients with conditions characterized by involuntary bladder contractions, cystometric studies have demonstrated that oxybutynin chloride increases bladder (vesical) capacity, diminishes the frequency of uninhibited contractions of the detrusor muscle, and delays the initial desire to void Oxybutynin chloride thus decreases urgency and the frequency of both incontinent episodes and voluntary urination.

The treatment of urinary urgency in males can be addressed with medications such as tolterodine and oxybutynin.

• Tolterodine has been evaluated in clinical studies for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.
• Oxybutynin has been shown to relax bladder smooth muscle, increasing bladder capacity and diminishing the frequency of uninhibited contractions of the detrusor muscle, thus decreasing urgency. However, the provided drug labels do not specifically address the treatment of urinary urgency in males, as the majority of patients in the studies were female (78%) 2 3.

From the Research

Urinary Urgency in Males

• Urinary urgency in males is a common symptom associated with various conditions, including overactive bladder (OAB) and benign prostatic hyperplasia (BPH) 4, 5.
• The pathophysiological mechanisms of OAB and BPH are complex and involve multiple factors, including bladder outlet obstruction, detrusor overactivity, and prostate enlargement 4, 6.
• Treatment options for urinary urgency in males include lifestyle modifications, pelvic floor muscle training, bladder retraining, and medical therapy, such as antimuscarinics and alpha-blockers 4, 7, 8.

Causes of Urinary Urgency

• Benign prostatic hyperplasia (BPH) is a common cause of urinary urgency in males, particularly in those over 50 years of age 5.
• Overactive bladder (OAB) is another common cause of urinary urgency, characterized by symptoms such as frequency, urgency, and nocturia 4, 6, 8.
• Other conditions, such as heart failure, urinary tract infections, and diabetes, can also contribute to urinary urgency in males 5.

Treatment Strategies

• Conservative management, including lifestyle modifications and pelvic floor muscle training, is often recommended as the first-line treatment for urinary urgency in males 7.
• Antimuscarinics, alone or in combination with alpha-blockers, can be effective in treating OAB symptoms, including urinary urgency, in males 6, 8.
• Surgical options, such as prostate surgery, may be considered in severe cases of BPH or OAB that do not respond to medical therapy 4, 5.