Pathophysiology and male lower urinary tract symptoms

In the past, older male with frequency, weak stream, hesitancy nocturia has prostatism implying his symptoms are related to benign prostatic hyperplasia (BPH). Recently, it was recognized that such symptoms are not a surrogate for BPH. Lower urinary tract symptoms (LUTS) have many causes, of which BPH is but one. The pathophysiology of LUTS is multifactorial. Bladder outlet obstruction (BOO) is one of the principal causes of LUTS: in addition to BOO, detrusor factors such as detrusor overactivity and detrusor underactivity can contribute to the development of LUTS. Of the men with LUTS, lots of them exhibited non-obstructed causes of LUTS in the urodynamic analysis. Increased awareness that there are multifactorial causes of LUTS became a force in changing the pattern of management. Therefore, relieving BOO such as debulking of the prostate mass may not be crucial for solution of LUTS. Aims of the treatment of LUTS also changed from the reducing obstruction and increasing the flow to the patient quality of life and satisfaction by using medical therapy such as alpha-adrenoceptor blockers. This review summarized the multifactorial causes of LUTS in men based on recent literatures.