{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T17:31:13Z","timestamp":1772559073678,"version":"3.50.1"},"reference-count":109,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Urology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p> The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of \u03b23 adrenoceptor agonists. However, different combinations have been investigated, and the long-term use of these compounds has raised new concerns about adherence and safety. This review summarizes the current state of pharmacology for LUTS, and presents a thorough discussion of the possible challenges concerning their future use. In this narrative review, we analyze the most recent articles related to LUTS pharmacotherapy, after an initial review of mechanisms of bladder function relevant in present clinical practice. The main problems with pharmacotherapy in LUTS are associated with its moderate efficacy, low persistence on treatment, and the incidence of short- and long-term adverse events (AE) associated with some compounds. The long-term AE, such as cognitive impairment in the elderly vulnerable patients associated with antimuscarinic drugs or persistent erectile dysfunction in sexually active men after treatment with 5-\u03b1-reductase inhibitors (5-ARI), are some of the problems addressed in this review. Combination therapy taking advantage of the synergistic mechanisms of action between some classes of compounds may overcome AE associated with dose escalation. LUTS pharmacotherapy offers moderate results to most patients but not a full cure. The use of combination drugs to achieve better clinical results, reduce AE and improve both efficacy and adherence, will be used more frequently in the future. The recently raised concern on potential long-term irreversible AE associated with some of these drugs, like antimuscarinics and 5-ARI, are critically important and require further investigation. <\/jats:p>","DOI":"10.1177\/1756287220922425","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T05:38:59Z","timestamp":1589434739000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Pharmacology of the lower urinary tract: update on LUTS treatment"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4304-7023","authenticated-orcid":false,"given":"Pedro","family":"Abreu-Mendes","sequence":"first","affiliation":[{"name":"Department of Urology in Hospital de S\u00e3o Jo\u00e3o, Alameda Professor Hern\u00e2ni Monteiro, Porto, 4200-319, Portugal"},{"name":"Faculty of Medicine of Porto, Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Faculty of Medicine of Porto, Porto, Portugal"},{"name":"i3S Institute Investigation and Innovation in Health"}]},{"given":"Francisco","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Faculty of Medicine of Porto, Porto, Portugal"},{"name":"i3S Institute Investigation and Innovation in Health"}]}],"member":"179","published-online":{"date-parts":[[2020,5,13]]},"reference":[{"key":"bibr1-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-16499-6_6"},{"key":"bibr2-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjp.0706604"},{"key":"bibr3-1756287220922425","volume-title":"Paper Presented at 45th Annual Meeting of the International Continence Society Meeting","author":"Moldwin R"},{"key":"bibr4-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24272"},{"key":"bibr5-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2013.04.042"},{"key":"bibr6-1756287220922425","first-page":"581","volume":"56","author":"Andersson KE","year":"2004","journal-title":"Am Soc Pharmacol Exp Ther"},{"key":"bibr7-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjp.0706780"},{"key":"bibr8-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2009.12.013"},{"key":"bibr9-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1111\/j.1474-8673.2006.00368.x"},{"key":"bibr10-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000067621.62736.7c"},{"key":"bibr11-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.116.237313"},{"key":"bibr12-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1002\/nau.23224"},{"key":"bibr13-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2017.43"},{"key":"bibr14-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2016.04.009"},{"key":"bibr15-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2009.04115.x"},{"key":"bibr16-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.07.007"},{"key":"bibr17-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2006.08.041"},{"key":"bibr18-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-9056(03)80559-6"},{"key":"bibr19-1756287220922425","volume-title":"presented at the annual EAU Congress","author":"Burkhard FC","year":"2019"},{"key":"bibr20-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2006.06.007"},{"key":"bibr21-1756287220922425","doi-asserted-by":"publisher","DOI":"10.2147\/tcrm.1.2.157.62912"},{"key":"bibr22-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/820816"},{"key":"bibr23-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.purol.2016.12.011"},{"key":"bibr24-1756287220922425","volume":"1","author":"Madhuvrata P","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr25-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2009.09086.x"},{"key":"bibr26-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2005.05454.x"},{"key":"bibr27-1756287220922425","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.08.060"},{"key":"bibr28-1756287220922425","unstructured":"Burkhard FC, Bosch JLHR, Cruz F, et al. 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