Evolución en el tratamiento médico de los síntomas del tracto urinario bajo en hombres

There have been radical changes over the years in the approach to and understanding of the male patient with lower urinary tract symptoms (LUTS). The simplistic vision that centered on prostate growth has been abandoned and substituted by an integrated approach that includes bladder, renal, neurologic, and bladder outlet function as causal factors. We now know that the bladder pays a crucial role in the presence and characteristics of LUTS and that these problems can be caused by bladder outlet obstruction due to the growth of the prostate, as well as to characteristic bladder changes secondary to aging and pelvic ischemia, similar to those observed in women with no type of obstruction. From this new perspective, we have incorporated numerous drugs into our armamentarium that act on different sites of both the upper and lower urinary tract. The management approach to the patient with LUTS is no longer a strictly surgical one and the disease is viewed as a chronic degenerative pathology that requires integrated management. Surgery remains an option in certain cases, but with the wide variety of available medication we can choose the treatment that best fits each patient. The aim of our review was to describe an integrated approach to the management of the LUTS patient, presenting all the currently available options, pointing out their advantages and disadvantages. We also attempted to provide a basis for choosing and formulating the combinations enabling the individualized treatment of these patients.