There are two types of refractory nocturnal enuresis. The first type corresponds to patients who are refractory from initial success, and the second type refers to refractory nocturnal enuresis after long-term success, in patients who cannot discontinue medications for enuresis. In the former type, it is necessary to determine whether the timing of medications is appropriate, whether the usage of antidiuretics is appropriate, whether any lifestyle changes have taken place, and whether there are secondary causes of enuresis. In the latter type, enuretic alarm treatment should be considered initially, and it is then important to investigate whether a respiratory obstruction is present in patients with nocturnal polyuria, whether the patient is constipated, and whether patients with non-monosymptomatic nocturnal enuresis have lower urinary tract symptoms or attention deficit hyperactivity disorder.
Attention Deficit Disorder with Hyperactivity ; Drug Resistance ; Drug Therapy ; Enuresis ; Humans ; Life Style ; Lower Urinary Tract Symptoms ; Nocturnal Enuresis* ; Polyuria

Medication has become the first-line option for the management of lower urinary tract symptoms induced by benign prostatic hyperplasia (LUTS/BPH) for its advantages in controlling the symptoms, inhibiting BPH progression, and reducing serious complications and surgical risks. Recent years have witnessed remarkable achievement in the studies of phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of LUTS/BPH. PDE5-Is can effectively alleviate LUTS/BPH, with even better efficacy when combined with al-ARAs.
Humans ; Lower Urinary Tract Symptoms ; drug therapy ; etiology ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Prostatic Hyperplasia ; complications

PURPOSE: To review the clinical outcomes of patients with voiding dysfunction who have detrusor overactivity with impaired contractility (DOIC) diagnosed with urodynamic studies. METHODS: Urodynamic reports from 2005 to 2009 were reviewed, and 54 male patients had findings consistent with DOIC. Patients with acontractile or neuropathic bladders were excluded. Clinical outcomes were obtained from patient records. RESULTS: Of 54 men, 8 presented with voiding symptoms, 17 had storage symptoms, and 29 had mixed symptoms. Twenty-two had a previous transurethral resection of the prostate. The median follow-up was 12 months. Four patients received no intervention. Two patients were taught intermittent self-catheterization. Five patients underwent surgery to reduce outlet resistance and all reported improvement. Forty-three patients were started on pharmacotherapy; symptomatic improvement was reported by 9 of 16 patients commenced on anticholinergics alone, 6 of 16 on alpha-blockers alone, and 4 of 5 treated with a combination of alpha-blockers and anticholinergics. Eleven patients experienced no difference on pharmacotherapy and 2 reported deterioration. One patient developed acute urinary retention (18 months after commencing treatment with alpha-blockers). No patient had urosepsis. CONCLUSIONS: Anticholinergics and alpha-blockers appear to be safe in patients with DOIC. The risk of urinary retention and sepsis is low. The majority of patients report symptomatic benefit from either drugs or surgical treatment.
Adrenergic alpha-Antagonists ; Cholinergic Antagonists ; Drug Therapy ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Sepsis ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Retention ; Urodynamics

Lower urinary tract dysfunction increases with age. Detrusor overactivity, detrusor underactivity, and detrusor hyperreflexia with impaired contractility are more common in elderly population. The elderly patients usually have cormobidities, comedications, and precipitation factors, which cause or exacerbate urinary symptoms, or aggravate subclinical lower urinary tract dysfunction to overwhelming diseases. Pharmacokinetics and pharmacodynamics changes with age. Older patients may refuse appropriate therapy because they are concerned about adverse effects, and economic burden. Thus strategy for the diagnosis and the management of lower urinary tract dysfunction in elderly might be different from those in young population. The diagnostic evaluation of these patients starts with history taking and non-invasive tests to make a plan to treat patient's symptom. Watchful waiting with lifestyle intervention is a good treatment modality. If pharmacotheraphy is planned, it would be better to start with low dose, then escalate dose. Adverse effects of medications are more common in elderly patients not by old age, but by comorbidity and comedication. First follow up might be in a short period after prescription when adverse effects usually occur.
Aged ; Comorbidity ; Diagnosis* ; Drug Therapy ; Follow-Up Studies ; Geriatrics ; Humans ; Life Style ; Lower Urinary Tract Symptoms ; Pharmacokinetics ; Prescriptions ; Reflex, Abnormal ; Urinary Tract* ; Watchful Waiting

Phosphodiesterase type 5 (PDE5) inhibitors are the most classic first-line medicine for male erectile dysfunction. Recent researches have demonstrated that PDE5 inhibitors can also be employed in the treatment of lower urinary tract symptoms, renal ischemia/reperfusion injury and testicular torsion. This article updates the application of PDE5 inhibitors in these fields and their relevant mechanisms.
Humans ; Lower Urinary Tract Symptoms ; drug therapy ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Reperfusion Injury ; drug therapy ; Spermatic Cord Torsion ; drug therapy ; Treatment Outcome

Tadalafil, as a selective phosphodiesterase type 5 inhibitor (PDE5I), has revolutionized the treatment of erectile dysfunction (ED) in men. Conventional management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), which is highly complex and likely multifactorial, is associated with unwanted side effects. Innovative once-daily tadalafil regimen is effective in treating the signs and symptoms of BPH. In recent trials in men with BPH, tadalafil significantly improved total IPSS over the initial 12 weeks of medication. Moreover, tadalafil is effective in treating both ED and the signs and symptoms of BPH. In this study, we review the current state of this new management strategy for LUTS secondary to BPH, highlighting the published reports on the efficacy and tolerability of tadalafil.
Carbolines ; therapeutic use ; Humans ; Lower Urinary Tract Symptoms ; drug therapy ; etiology ; Male ; Prostatic Hyperplasia ; complications ; drug therapy ; Retrospective Studies ; Tadalafil ; Treatment Outcome

OBJECTIVETo determine whether oral statins can delay the progression of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).

METHODSWe conducted a retrospective cohort study of 50-69-year-old males who came for physical examination in our hospital between January 2003 and December 2008. We designed the inclusion criteria, followed them up for 5 years, and investigated the relationship of oral statins with the clinical progression of BPH and LUTS.

RESULTSTotally, 653 men met the inclusion criteria and were included in this study, of whom 283 were treated with oral statins (group 1) while the other 370 with none (group 2). There were no statistically significant differences between the two groups in age and baseline IPSS, Qmax, and prostate volume (PV) (P > 0.05). During the follow-up, 24 cases in group 1 and 35 cases in group 2 were excluded for obvious dys-uria. A gradual increase was observed in IPSS in both groups 1 and 2 year by year from the baseline to the 5th year of follow-up, but significantly lower in the former group (4.27 +/- 1.16, 4.63 +/- 1.05, 5.27 +/- 0.96, 6.41 +/- 1.04, 7.21 +/- 1.21, and 7.93 +/-1.50) than in the latter (4.24 +/- 1.35, 5.26 +/- 1.23, 6.84 +/- 1.20, 8.75 +/- 1.84, 10.82 +/- 3.01, and 12.98 +/- 4.21) (P < 0.01); a gradual decrease was seen in Qmax, though markedly higher in group 1 ([26.56 +/- 2.09], [24.06 +/- 1.94], [21.33 +/- 1.66], [19.24 +/- 1.54], [17.44 +/- 1.53], and [16.27 +/- 1.37] ml/s) than in group 2 ([26.74 +/- 2.40], [23.62 +/- 2.01], [20.63 +/- 1.69], [17.72 +/- 1.48], [14.82 +/- 1.11], and [11.86 +/- 1.24] ml/s) (P < 0.01); and a gradual increase was found in PV, but remarkably smaller in the former group ([19.82 +/- 4.94], [22.60 +/- 4.99], [25.80 +/- 5.20], [27.92 +/- 5.05], [29.11 +/- 5.24], and [29.97 +/- 5.26] ml) than in the latter ([20.21 +/- 4.78], [24.30 +/- 4.98], [28.50 +/- 5.14], [32.84 +/- 4.77], [36.99 +/- 4.78], and [40.90 +/- 4.78] ml) (P < 0.01). Longer medication of statins was associated with better efficacy.

CONCLUSIONOral statins can significantly delay the clinical progression of BPH and LUTS.

Aged ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Longitudinal Studies ; Lower Urinary Tract Symptoms ; drug therapy ; Male ; Middle Aged ; Prostatic Hyperplasia ; drug therapy ; Retrospective Studies

Saw palmetto fruit extract (SPE), as a herbal product, is widely used for the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Recent studies show that SPE also has some therapeutic effects on chronic prostatitis, prostate cancer, sexual dysfunction, and so on. This article presents an overview on the application of SPE in the treatment of BPH, prostate cancer, and chronic prostatitis/chronic pelvic pain syndrome, with a discussion on its action mechanisms.
Chronic Disease ; Fruit ; chemistry ; Humans ; Lower Urinary Tract Symptoms ; drug therapy ; Male ; Pelvic Pain ; drug therapy ; Plant Extracts ; therapeutic use ; Prostatic Diseases ; drug therapy ; Prostatic Hyperplasia ; drug therapy ; Prostatic Neoplasms ; drug therapy ; Prostatitis ; drug therapy ; Syndrome

Primary lymphomas of the prostate are extremely rare and can mimic other more common prostatic lesions. We report a case of a primary diffuse large B-cell lymphoma of the prostate in a 59 years old man, who presented with lower urinary tract symptoms, gross hematuria and enlargement of the prostate on digital rectal examination. On microscopic examination, the tumor, composed of diffuse large cells, with B cell immunophenotypes, was diagnosed as a non-Hodgkin's lymphoma. After the histological diagnosis, the patient underwent 6 cycles of combination chemotherapy, with cyclophosphamide, doxorubicin, vincristine and prednisone, followed by involved-field radiation therapy. He is followed well for 5 months without any problem.
Cyclophosphamide ; Diagnosis ; Digital Rectal Examination ; Doxorubicin ; Drug Therapy, Combination ; Hematuria* ; Humans ; Lower Urinary Tract Symptoms ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prednisone ; Prostate* ; Vincristine

Ketamine is a short-acting anaesthetic agent that has gained popularity as a 'club drug' due to its hallucinogenic effects. Substance abuse should be considered in young adult patients who present with severe debilitating symptoms such as lower urinary tract symptoms, even though the use of controlled substances is rare in Singapore. Although the natural history of disease varies from person to person, a relationship between symptom severity and frequency/dosage of abuse has been established. It is important to be aware of this condition and have a high degree of clinical suspicion to enable early diagnosis and immediate initiation of multidisciplinary and holistic treatment. A delayed diagnosis can lead to irreversible pathological changes and increased morbidity among ketamine abusers.
Adult ; Cystitis ; drug therapy ; Cystoscopy ; Female ; Fluoroscopy ; Humans ; Ketamine ; adverse effects ; Lower Urinary Tract Symptoms ; chemically induced ; Male ; Singapore ; Substance-Related Disorders ; complications ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Tract ; drug effects ; physiopathology ; Young Adult