Management of Urological Irritative Symptoms

Definition and Diagnosis

Irritative urinary symptoms are storage-related lower urinary tract symptoms (LUTS) that include urgency, frequency, nocturia, and sometimes pain or discomfort during urination, as defined by the European Association of Urology 1
The International Prostate Symptom Score (IPSS) is a validated symptom questionnaire used to quantify severity, recommended by the European Association of Urology 2
A frequency-volume chart for at least 3 days is recommended, especially when nocturia is prominent, by the European Association of Urology 2

Overactive bladder (OAB) is characterized by urgency with or without urge incontinence, according to the European Association of Urology 1
Benign prostatic obstruction (BPO) often presents with both obstructive and irritative symptoms, as noted by the European Association of Urology 1
Neurological conditions affecting bladder function can cause irritative symptoms, as reported by the European Association of Urology 3

Lifestyle modifications and behavioral interventions should be offered to all patients with irritative LUTS prior to or concurrent with pharmacological treatment, as recommended by the European Association of Urology 1
Muscarinic receptor antagonists (antimuscarinics) are strongly recommended for men with moderate-to-severe LUTS with predominant storage symptoms, according to the European Association of Urology 1
Beta-3 agonists (mirabegron) are recommended for men with moderate-to-severe LUTS with predominant storage symptoms, as noted by the European Association of Urology 1
Alpha-1 blockers (tamsulosin, alfuzosin) are recommended as first-line therapy for men with mixed obstructive and irritative symptoms, according to the European Association of Urology 1
5-alpha-reductase inhibitors (finasteride, dutasteride) are recommended for men with enlarged prostates (>40 ml), as reported by the European Association of Urology 1

Assess response to alpha-blockers after 2-4 weeks, as recommended by the European Association of Urology 2
Evaluate 5-ARI therapy after 3 months, according to the European Association of Urology 2
Monitor post-void residual (PVR) volume when using antimuscarinic agents, as noted by the European Association of Urology 1
Annual follow-up is recommended for stable patients, according to the European Association of Urology 2