Treatment Options for Urinary Frequency in Men
Initial Evaluation
- The American Urological Association recommends obtaining a thorough medical history, conducting a physical examination including digital rectal examination (DRE), utilizing the International Prostate Symptom Score (IPSS), and performing urinalysis for all men presenting with urinary frequency 1, 2
- A frequency-volume chart (FVC) should be completed for 3 days, especially when nocturia is a significant component of the symptoms 3, 4
- The degree of bother and impact on quality of life should be assessed, as this should guide treatment decisions 1, 2
- Measuring post-void residual (PVR) volume can help evaluate for urinary retention 1, 5
Understanding the Causes
- Benign prostatic hyperplasia (BPH) causing benign prostatic obstruction (BPO) is the most common cause of urinary frequency in men over 50 1
- Overactive bladder (OAB) syndrome can occur independently or secondary to BPH 1, 6
- Nocturnal polyuria, or excessive urine production at night, can also contribute to urinary frequency 7, 3
- Urinary tract infections can cause urinary frequency 5
Treatment Algorithm
- Alpha-blockers, such as tamsulosin or alfuzosin, are recommended as first-line therapy for most men with lower urinary tract symptoms (LUTS) 1
- For men with a prostate size greater than 30cc, adding 5-alpha reductase inhibitors (5ARIs) such as finasteride or dutasteride may be considered 1
- Phosphodiesterase-5 inhibitors, such as tadalafil, can be used as an alternative option, especially for men with concurrent erectile dysfunction 1
- Anticholinergics, such as trospium or oxybutynin, can be used to treat overactive bladder (OAB) symptoms 1, 6
Special Considerations
- Men with predominant nocturia should be evaluated for nocturnal polyuria (>33% of 24-hour urine output occurring at night) 7, 6
- Combination therapy should be considered when monotherapy fails 1