Voiding symptoms in benign prostatic obstruction

Medical Information

Introduction

Voiding symptoms associated with an enlarged prostate are also summarized under the term Lower Urinary Tract Symptoms (LUTS). They are characterized by frequent urination (pollakiuria), a weak urinary stream, and even urinary retention. Relatively effective pharmacological alternatives have existed for some time, such as alpha-blockers or 5-alpha-reductase inhibitors, but these are also characterized by certain side effects (hypotension, loss of libido).

It has been experimentally demonstrated in animals that Low-Intensity Extracorporeal Shockwave Therapy (Li-ESWT) leads to the stimulation of nitric oxide synthase, resulting in the relaxation of the bladder neck.

This finding served as the basis for clinical trials using Li-ESWT in patients with LUTS. While Li-ESWT cannot replace surgical therapy (such as transurethral resection of the prostate —TURP— or laser enucleation), a recent meta-analysis suggests that Li-ESWT may be equivalent to pharmacological therapy.

Recent clinical and anatomical studies indicate that, similar to chronic pelvic syndrome, there is a functional dysfunction of the urogenital system due to myofascial structures (fascial adhesions, trigger points, etc.).

Diagnosis

The diagnosis includes a physical examination comprising digital rectal palpation, as well as the exploration of myofascial trigger points (MTrPs), transrectal ultrasound, uroflowmetry, and determination of residual urine. It is also important to objectify voiding symptoms using a standardized questionnaire (IPSS score).

(Additionally, an evaluation of myofascial trigger points in the extended pelvic region —lumbar spine, lower extremities— should be performed).

Focused Extracorporeal Shockwave Therapy (focused ESWT) is particularly suitable for this type of diagnosis, as it allows deep MTrPs to be reached without difficulty and, thanks to patient feedback, enables the precise classification of the myofascial component of the symptoms.

Therapy

• Medications: alpha-blockers, 5-alpha reductase inhibitors, tadalafil.

• ESWT: The application of shock waves is similar to the treatment for chronic pelvic pain. No side effects were observed.

• Surgical therapy: transurethral resection of the prostate (TURP), laser enucleation, as established procedures.