Management of Persistent Storage Symptoms and Overactive Bladder in Men Diagnosed with Benign Prostatic Hyperplasia: A Narrative Review

Benign prostatic hyperplasia (BPH) and overactive bladder (OAB) both cause lower urinary tract symptoms (LUTS) in men. Ongoing urgency, frequency, and nocturia despite effective BPH management may indicate coexistence of primary OAB in many individuals. A literature search was conducted to support a narrative review aimed at enhancing awareness that urinary symptoms in men should not be attributed solely to either BPH or OAB, as LUTS have numerous etiologies, and OAB and BPH are both prevalent among men. Owing to different etiologies of BPH and OAB, LUTS in men may not be adequately addressed with a single treatment. BPH medications primarily target voiding-related symptoms, and storage-related symptoms may persist. Storage-related symptoms (i.e., OAB) are generally the most bothersome and frequently reported element of LUTS, reducing quality of life, and studies suggest that OAB in men is inadequately addressed. Furthermore, men with both BPH and OAB seldom receive treatment for OAB after BPH management, if at all. Thus, men may benefit from clinicians prescribing OAB medication alongside those for BPH. This approach has been evaluated in clinical trials, some of which have shown improvements in OAB symptoms among men with BPH, without introducing additional safety concerns. Proactive discussions about symptoms, especially in the primary care setting, may help facilitate timely and effective treatment of this common issue. There are established OAB treatments that can be safely and successfully combined with BPH management to effectively address persistent storage symptoms and complex urinary symptoms in men.