An evidence based update on the investigation and management of male lower urinary tract symptoms


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Abstract

In this review, we aim to summarise the evidence regarding the diagnosis and management of male Lower urinary tract symptoms (LUTS). It is inevitable that with an ageing population the prevalence of male LUTS is likely to increase. Thus symptom prevention and preservation of quality of life (QoL) feature as high priorities for clinicians and patients alike. There are now a number of different pharmacological options available to men with LUTS which lead to significant improvements in symptom scores, flow rate and QoL. Meta-analyses have shown the benefits for 5-а reductase inhibitors, antimuscarinics, alpha blockers and more recently the phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above agents with alpha blockers except phosphodiesterase-5 inhibitors and so men with concomitant storage symptoms, prostate volume >30ml/ PSA>1.4 or erectile dysfunction may be considered for combination treatment. The last few years have seen an increase in the data regarding less invasive methods of cystometry. Although these do not provide the same information as cystometry, they may have a role in answering specific questions and counselling men with BPH/LUTS. The key to incorporating these newer techniques in the assessment of men will lie with standardisation and use for specific indications. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical investigative and management strategy.

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About the authors

Altaf Mangera

Sheffield Teaching Hospital

Email: mangeraaltaf@hotmail.com
Clinical Research Fellow UK

Ch. Chapple

Sheffield Teaching Hospital

UK

References

  1. Haidinger G., Waldhor T., Madersbacher S., Schatzl G., Vutuc C. Prevalence of lower urinary tract symptoms in Austrian males: update 2009. Urol. Int. 2011;87:385-391.
  2. Tuncay A.F., Aygun C, Bilir N, Erkan I., Ozen H. Prevalence of lower urinary tract symptoms in a community-based survey of men in Turkey. Int. J. Urol. 2003;10:364-370.
  3. Boyle P., Robertson C., Mazzetta C., Keech M., Hobbs F.D., Fourcade R, Kiemeney L, Lee C. The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik. study. BJU Int.2003;92:409-414.
  4. Seim A., Hoyo C, Ostbye T, Vatten L. The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT study. BJU Int. 2005;96:88-92.
  5. Shamliyan T.A., Wyman J.F., Ping R., Wilt T.J., Kane R.L. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev. Urol. 2009;11:145-165.
  6. Homma Y., Yamaguchi O., Hayashi K. Epidemiologic survey of lower urinary tract symptoms in Japan. Urology. 2006;68:560-564.
  7. Coyne K.S., Sexton C.C., Thompson C.L., Milsom I., Irwin D., Kopp Z.S., Chapple C.R., Kaplan S., Tubaro A., Aiyer L.P., Wein A.J. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104:352-360.
  8. Irwin D.E., Milsom I., Kopp Z., Abrams P., Artibani W., Herschorn S. Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of overactive bladder. Eur. Urol. 2009;56:14-20.
  9. Malmsten U.G., Molander U., Peeker R., Irwin D.E., Milsom I. Urinary incontinence, overactive bladder, and other lower urinary tract symptoms: a longitudinal population-based survey in men aged 45-103 years. Eur. Urol. 2010;58:149-156.
  10. Fukuta F., Masumori N., Mori M., Tsukamoto T. Natural history of lower urinary tract symptoms in Japanese men from a 15-year longitudinal community-based study. BJU Int. 2012;10:1023-1029.
  11. Irwin D.E., Milsom I., Kopp Z., Abrams P. Symptom bother and health care-seeking behavior among individuals with overactive bladder. Eur. Urol. 2008;53:1029-1037.
  12. Braun M.H., Sommer F., Haupt G., Mathers M.J., Reifenrath B., Engelmann U.H. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical «Aging Male» symptoms? Results of the «Cologne Male Survey». Eur. Urol. 2003;44:588-594.
  13. Parsons J.K., Messer K., White M., Barrett-Connor E., Bauer D.C., Marshall L.M. Obesity increases and physical activity decreases lower urinary tract symptom risk in older men: the Osteoporotic Fractures in Men study. Eur. Urol. 2011;60: 1173-1180.
  14. Martin S.A., Haren M.T., Marshall V.R., Lange K., Wittert G.A. Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men. World J. Urol. 2011;29:179-184.
  15. Ohgaki K., Hikima N., Horiuchi K., Kondo Y. Association between metabolic syndrome and male lower urinary tract symptoms in Japanese subjects using three sets of criteria for metabolic syndrome and International Prostate Symptom Score. Urology. 2011; 77:1432-1438.
  16. Maserejian N.N., Giovannucci E.L., McVary K.T., McKinlay J.B. Dietary, but not supplemental, intakes of carotenoids and vitamin C are associated with decreased odds of lower urinary tract symptoms in men. J. Nutr. 2011;141:267-273.
  17. Rohrmann S., Crespo C.J., Weber J.R., Smit E., Giovannucci E., Platz E.A. Association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms in older American men: findings from the third National Health And Nutrition Examination Survey. BJU Int. 2005;96:77-82.
  18. Cartwright R., Mangera A., Tikkinen K.A., Rajan P., Pesonen J., Kirby A.C., Thiagamoorthy G., Ambrose C., Gonzalez-Maffe J., Bennett P.R., Palmer T., Walley A., Jarvelin M.R., Khullar V., Chapple C. Systematic Review and Meta-analysis of Candidate Gene Association Studies of Lower Urinary Tract Symptoms in Men. Eur. Urol. 2014;66(4):752-768.
  19. Abrams P., Cardozo L., Fall M., Griffiths D., Rosier P., Ulmsten U., Van Kerrebroeck P., Victor A., Wein A. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn. 2002;21:167-178.
  20. Khullar V. Patient-reported outcomes and different approaches to urinary parameters in overactive bladder: what should we measure? Int. Urogynecol. J. 2012;23:179-192.
  21. Yap T.L., Cromwell D.C., Emberton M. A systematic review of the reliability of frequency-volume charts in urological research and its implications for the optimum chart duration. BJU Int. 2007;99:9-16.
  22. McConnell J.D., Roehrborn C.G., Bautista O.M., Andriole G.L., Dixon C.M., Kusek J.W., Lepor H., McVary K.T., Nyberg L.M., Clarke H.S., Crawford E.D., Diokno A., Foley J.P., Foster H.E., Jacobs S.C., Kaplan S.A., Kreder K.J., Lieber M.M., Lucia M.S., Miller G.J., Menon M., Milam D.F., Ramsdell J.W., Schenkman N.S., Slawin K.M., Smith J.A. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N. Engl. J. Med. 2003;349:2387-2398.
  23. Roehrborn C.G. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int. 2006;97:734-741.
  24. Roehrborn C.G.,Boyle P., Bergner D., Gray T., Gittelman M., Shown T., Melman A., Bracken R.B., deVere W.R., Taylor A., Wang D., Waldstreicher J. Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. PLESS Study Group. Urology. 1999;54:662-669.
  25. Miah S., Catto J. BPH and prostate cancer risk. Indian J. Urol. 2014;30:214-218.
  26. McConnell J.D., Roehrborn C.G., Bautista O.M., Andriole G.L., Dixon C.M.,Kusek J. W.,Lepor H., cVary K. T.,Nyberg L.M., Clarke H.S., Crawford E.D., Diokno A., Foley J.P., Foster H.E., Jacobs S.C., Kaplan S.A., Kreder K.J., Lieber M.M., Lucia M.S., Miller G.J., Menon M., Milam D.F., Ramsdell J.W., Schenkman N.S., Slawin K.M., Smith J.A. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N. Engl. J. Med. 2003;349:2387-2398.
  27. Oelke M., Baard J., Wijkstra H., de la Rosette J.J., Jonas U., HofnerK. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur. Urol. 2008;54:419-426.
  28. Hashim H., Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J. Urol. 2006;175:191-194.
  29. Wyndaele J.J., De W.S. Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval. Eur. Urol. 2002;42:34-38.
  30. Kageyama S., Watanabe T., Kurita Y., Ushiyama T., Suzuki K., Fujita K. Can persisting detrusor hyperreflexia be predicted after transurethral prostatectomy for benign prostatic hypertrophy? Neurourol. Urodyn. 2000;19:233-240.
  31. Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84:14-15.
  32. Thomas A.W., Cannon A., Bartlett E., Ellis-Jones J., Abrams P. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int. 2004;93:745-750.
  33. Jeong S.J., Kim H.J., Lee Y.J., Lee J.K., Lee B.K., Choo Y.M., Oh J.J., Lee S.C., Jeong C.W., Yoon C.Y., Hong S.K., Byun S.S., Lee S.E. Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women. Korean J. Urol. 2012;53:342-348.
  34. Rodrigues P., Lucon A.M., Freire G.C., Arap S. Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. J. Urol. 2001;165:499-502.
  35. Witjes W.P., Aarnink R.G., Ezz-el-Din K., Wijkstra H., Debruyne E.M., de la Rosette J.J. The correlation between prostate volume, transition zone volume, transition zone index and clinical and urodynamic investigations in patients with lower urinary tract symptoms. Br. J. Urol. 1997;80:84-90.
  36. Lieber M.M., Jacobson D.J., McGreeM.E., StSauver J.L., Girman C.J., Jacobsen S.J. Intravesical prostatic protrusion in men in Olmsted County, Minnesota. J. Urol. 2009;182:2819-2824.
  37. Cumpanas A.A., Botoca M., Minciu R., Bucuras F.Intravesical prostatic protrusion can be a predicting factor for the treatment outcome in patients with lower urinary tract symptoms due to benign prostatic obstruction treated with tamsulosin. Urology. 2013;81:859-863.
  38. Seo Y.M., Kim H.J. Impact of intravesical protrusion of the prostate in the treatment of lower urinary tract symptoms/benign prostatic hyperplasia of moderate size by alpha receptor antagonist. Int. Neurourol. J. 2012;16:187-190.
  39. Lee J.W., Ryu J.H., Yoo T.K., Byun S.S., Jeong Y.J., Jung T.Y. Relationship between Intravesical Prostatic Protrusion and Postoperative Outcomes in Patients with Benign Prostatic Hyperplasia. Korean J. Urol. 2012;53:478-482.
  40. Aganovic D., Hasanbegovic M., Prcic A., Kulovac B., Hadziosmanovic O. Which is a better indicator of bladder outlet obstruction in patients with benign prostatic enlargement--intravesical protrusion of prostate or bladder wall thickness? Med. Arh. 2012;66:324-328.
  41. Franco G., De N.C., Leonardo C., Tubaro A., Ciccariello M., De D.C., Miano L., Laurenti C. Ultrasound assessment of intravesical prostatic protrusion and detrusor wall thickness - new standards for noninvasive bladder outlet obstruction diagnosis? J. Urol. 2010;183:2270-2274.
  42. Syazarina S.O., Zulkifli M.Z., Hamzaini A.H. Predicting outcome of trial of voiding without catheter in acute urinary retention with intravesical prostatic protrusion. Malays J. Med. Sci. 2013; 20:56-59.
  43. Ku J.H., Ko D.W., Cho J.Y., Oh S.J. Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms. Urology. 2010;75:1467-1471.
  44. Bright E., Oelke M., Tubaro A., Abrams P. Ultrasound estimated bladder weight and measurement of bladder wall thickness - useful noninvasive methods for assessing the lower urinary tract? J. Urol. 2010;184:1847-1854.
  45. Manieri C., Carter S.S., Romano G., Trucchi A., Valenti M., Tubaro A. The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness. J. Urol. 1998;159:761-765.
  46. Hakenberg O.W., Linne C., Manseck A., Wirth M.P. Bladder wall thickness in normal adults and men with mild lower urinary tract symptoms and benign prostatic enlargement. Neurourol. Urodyn. 2000;19:585-593.
  47. Oelke M., Hofner K., Jonas U., de la Rosette J.J., Ubbink D.T., Wijkstra H. Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur. Urol. 2007;52:827-834.
  48. Huang T., Qi J., Yu Y.J., Xu D., Jiao Y., Kang J., Chen Y.Q., Zhu Y.K. Predictive value of resistive index, detrusor wall thickness and ultrasound estimated bladder weight regarding the outcome after transurethral prostatectomy for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Int. J. Urol. 2012;19:343-350.
  49. Kessler T.M., Gerber R., Burkhard F.C., Studer U.E., Danuser H. Ultrasound assessment of detrusor thickness in men-can it predict bladder outlet obstruction and replace pressure flow study? J. Urol. 2006;175:2170-2173.
  50. Oelke M. International Consultation on Incontinence-Research Society (ICI-RS) report on non-invasive urodynamics: the need of standardization of ultrasound bladder and detrusor wall thickness measurements to quantify bladder wall hypertrophy. Neurourol. Urodyn. 2010;29:634-639.
  51. Gleason D.M., Bottaccini M.R., McRae L.P. Noninvasive urodynamics: a study of male voiding dysfunction. Neurourol. Urodyn. 1997;16:93-100.
  52. Griffiths C.J., Rix D., MacDonald A.M., Drinnan M.J., Pickard R.S., Ramsden P.D. Noninvasive measurement of bladder pressure by controlled inflation of a penile cuff. J. Urol. 2002;167:1344-1347.
  53. McIntosh S.L.,Drinnan M.J., Griffths C.J.,Robson W.A., Ramsden P.D., Pickard R.S. Noninvasive assessment ofbladder contractility in men. J. Urol. 2004;172:1394-1398.
  54. Drinnan M.J.,McIntosh S.L.,Robson W.A.,Pickard R.S.,Ramsden P.D., Griffiths C.J. Inter-observer agreement in the estimation of bladder pressure using a penile cuff. Neurourol. Urodyn. 2003;22: 296-300.
  55. Harding C.K., Robson W., Drinnan M.J., Ramsden P.D., Griffiths C., Pickard R.S. Variation in invasive and noninvasive measurements of isovolumetric bladder pressure and categorization of obstruction according to bladder volume. J. Urol. 2006;176:172-176.
  56. Borrini L., Lukacs B., Ciofu C., Gaibisso B., Haab F., Amarenco G. Predictive value of the penile cuff-test for the assessment of bladder outlet obstruction in men. Prog. Urol. 2012;22: 657-664.
  57. Harding C., Robson W., Drinnan M., Sajeel M., Ramsden P., Griffiths C., Pickard R. Predicting the outcome of prostatectomy using noninvasive bladder pressure and urine flow measurements. Eur. Urol. 2007;52:186-192.
  58. Boyle P., Robertson C., Lowe F., Roehrborn C. Updated metaanalysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93:751- 756.
  59. Wilt T., Ishani A., Mac D.R., Rutks I., Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst. Rev. 2002;CD001044.
  60. Wilt T.J., Macdonald R., Ishani A., Rutks I., Stark G. WITHDRAWN: Cernilton for benign prostatic hyperplasia. Cochrane Database Syst. Rev. 2011;CD001042.
  61. Yuan J., Liu Y., Yang Z., Qin X., Yang K., Mao C. The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: an overview of 15 systematic reviews. Curr. Med. Res. Opin. 2013;29:279-287.
  62. Kawabe K., Yoshida M., Homma Y.Silodosin, a new alpha1A- adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men. BJU Int. 2006;98:1019-1024.
  63. Bosch J.L. Urodynamic effects of various treatment modalities for benign prostatic hyperplasia. J. Urol. 1997;158:2034-2044.
  64. Chapple C.R., Khullar V., Gabriel Z., Muston D., Bitoun C.E., Weinstein D. The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur. Urol. 2008;54:543-562.
  65. Wu T., Duan X., Cao C.X., Peng C.D., Bu S.Y., Wang K.J. The role of mirabegron in overactive bladder: a systematic review and metaanalysis. Urol. Int. 2014;93:326-337.
  66. MacDiarmid S.A., Peters K.M., Chen A., Armstrong R.B., Orman C., Aquilina J.W., Nitti V.W. Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: randomized, double-blind, placebo- controlled study. Mayo Clin. Proc. 2008;83:1002-1010.
  67. Oesterling J.E. Endocrine therapies for symptomatic benign prostatic hyperplasia. Urology. 1994;43:7-16.
  68. Tenover J.L., Pagano G.A., Morton A.S., Liss C.L., Byrnes C.A. Efficacy and tolerability of finasteride in symptomatic benign prostatic hyperplasia: a primary care study. Primary Care Investigator Study Group. Clin. Ther. 1997;19:243-258.
  69. Andersen J.T., Ekman P., Wolf H., Beisland H.O., Johansson J.E., Kontturi M, Lehtonen T, Tveter K. Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo- controlled study. The Scandinavian BPH Study Group. Urology. 1995;46:631-637.
  70. Vaughan E.D. Long-Term Experience With 5-alpha-Reductase Inhibitors. Rev. Urol. 2003;5(5):S22-S27.
  71. Roehrborn C.G., Boyle P., Bergner D., Gray T., Gittelman M, Shown T., Melman A., Bracken R.B., deVere W.R., Taylor A., Wang D., Waldstreicher J. Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. PLESS Study Group. Urology. 1999;54:662-669.
  72. McConnell J.D., Roehrborn C.G., Bautista O.M., Andriole G.L., Dixon C.M., Kusek J.W., Lepor H., McVary K.T., Nyberg L.M., Clarke H.S., Crawford E.D., Diokno A., Foley J.P., Foster H.E., Jacobs S.C., Kaplan S.A., Kreder K.J., Lieber M.M., Lucia M.S., Miller G.J., Menon M., Milam D.F., Ramsdell J.W., Schenkman N.S., Slawin K.M., Smith J.A. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N. Engl. J. Med. 2003;349:2387-2398.
  73. Roehrborn C.G., McConnell J.D., Lieber M., Kaplan S., Geller J., Malek G.H., Castellanos R., Coffield S., Saltzman B., Resnick M., Cook T.J., Waldstreicher J. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology. 1999;53:473-480.
  74. Amory J.K., Wang C., Swerdloff R.S., Anawalt B.D., Matsumoto A.M., Bremner W.J., Walker S.E., Haberer L.J., Clark R.V. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J. Clin. Endocrinol. Metab. 2007;92:1659-1665.
  75. O’Leary M.P., Roehrborn C., Andriole G., Nickel C., Boyle P., Hofner K. Improvements in benign prostatic hyperplasia-specific quality of life with dutasteride, the novel dual 5alpha-reductase inhibitor. BJU Int. 2003;92:262-266.
  76. Nickel J.C., Gilling P., Tammela T.L., Morrill B., Wilson T.H., Rittmaster R.S. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 2011;108:388-394.
  77. Parsons J.K., Schenk J.M., Arnold K.B., Messer K., Till C., Thompson I.M., Kristal A.R. Finasteride reduces the risk of incident clinical benign prostatic hyperplasia. Eur. Urol. 2012;62:234-241.
  78. Toren P., Margel D., Kulkarni G., Finelli A., Zlotta A., Fleshner N. Effect of dutasteride on clinical progression of benign prostatic hyperplasia in asymptomatic men with enlarged prostate: a post hoc analysis of the REDUCE study. BMJ. 2013;346:f2109.
  79. Fullhase C., Chapple C., Cornu J.N., DeN.C., Gratzke C., Kaplan S.A., Marberger M., Montorsi F., Novara G., Oelke M., Porst H., Roehrborn C., Stief C., McVary K.T. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur. Urol. 2013;64:228-243.
  80. Roehrborn C.G., Barkin J., Tubaro A., Emberton M., Wilson T.H., Brotherton B.J., Castro R. Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study. BJU Int. 2014;113:623-635.
  81. Oelke M., Giuliano F., Mirone V., Xu L., Cox D., Viktrup L. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur. Urol. 2012;61:917-925.
  82. Donatucci C.F., Brock G.B., Goldfischer E.R., Pommerville P.J., Elion-Mboussa A., Kissel J.D., Viktrup L. Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a 1-year, open-label extension study. BJU Int. 2011;107:1110-1116.
  83. Gacci M., Corona G., Salvi M., Vignozzi L., McVary K.T., Kaplan S.A., Roehrborn C.G., Serni S., Mirone V., Carini M., Maggi M. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur. Urol. 2012;61:994-1003.
  84. Fullhase C., Chapple C., Cornu J.N., DeN.C., Gratzke C., Kaplan S.A., Marberger M., Montorsi F., Novara G., Oelke M., Porst H., Roehrborn C., Stief C., McVary K.T. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur. Urol. 2013;64:228-243.

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