The effect of testosterone replacement therapy on lower urinary tract symptoms (LUTS) in men.

Introduction. Currently, there is a point of view that lower urinary tract symptoms (LUTS) and age-related testosterone deficiency (hypogonadism) in men should be considered as pathogenetically interrelated, age-associated chronic diseases characterized by a progressive course. These conditions can significantly reduce the quality and duration of life in men in the absence of adequate drug correction. Over the past decades, a new understanding of the key role of testosterone in maintaining the normal anatomical and functional state of the lower urinary tract in men has emerged. This has led to a revision of the place of testosterone drugs in the treatment of LUTS. The aim of the study is to study the clinical efficacy and prostatic safety of testosterone replacement therapy (TRT) in men with testosterone deficiency (hypogonadism) and LUTS. Material and methods. The results of the examination and treatment of 45 men aged 40-70 years (mean age 56,3±3,2 years) with testosterone deficiency (hypogonadism) and LUTS (main group) and the results of the examination of 30 healthy men of the same age (control group) are presented. All men were surveyed using the IPSS-QL and AMS questionnaires; laboratory determination of blood levels of total PSA, total testosterone, sex hormone–binding globulin (SHBG), calculation of free testosterone levels using the Vermeulen nomogram; uroflowmetry with determination of the voided volume (VV) and the maximal flow rate (Qmax); ultrasound examination with determination of the prostate volume and residual urine, followed by statistical processing of the results according to standard methods. Results. The improvement of the studied parameters of the LUTS (IPSS-QL, Qmax, VV, prostate volume, residual urine volume) observed from 3 months of TRT was unreliable (p>0,05), and only from 6 months onwards the positive dynamics of the lower urinary tract against the background of TRT significantly differed from the initial indicators before treatment (p<0,05). With TRT for 12 months, the average frequency of nocturia in the main group significantly decreased from 66,7% to 33,3% (p<0,05). There were no significant correlations between the frequency of nocturia and prostate volume, however, a significant negative relationship was established between the level of free testosterone and the frequency of nocturia (n=45; r=–0,302; p<0,001). The 12–month TRT did not lead to a significant increase in the level of total blood PSA. The expected concomitant positive effect of TRT was the elimination of clinical symptoms of testosterone deficiency (hypogonadism) in the main group, which occurred on average after 6-12 months of TRT, with an improvement in a number of testosterone-dependent extraurinal health indicators. Conclusion. Testosterone deficiency (hypogonadism) in men is closely pathogenetically associated with LUTS/nocturia, and TRT is able to effectively and safely reduce their severity, provided that sufficiently long courses (at least 3 months) are carried out.