Treatment of Storage LUTS

Storage LUTS are highly influenced by behavioural traits, and correcting these is absolutely vital—all subsequent attempts at therapy may well fail if the basics are not properly addressed. The medications available are two main classes, the antimuscarinic drugs and a beta-3 adrenergic agonist. Antimuscarinics are well established and understood, but have significant side effects and limited efficacy which means most people stop taking them in a comparatively short time-frame. The beta-3 agonist is of comparable efficacy but generally has fewer side effects. Both drug classes have some specific contraindications. They can safely be used in combination for greater efficacy, and with no substantial increase in adverse effects. Refractory symptoms of overactive bladder may be treated with botulinum bladder injections if the patient has the aptitude and attitude to accept self-catheterization, which is needed in a minority. Sacral or tibial nerve stimulation are two established techniques which have rather differing profiles. For stress incontinence, surgical intervention is the main approach once conservative measures have properly been put in place. The operations for women are colposuspension, autologous sling and midurethral tape, but a major challenge is emerging for the latter as a result of problems from using mesh in vaginal surgery. For men, the interventions are artificial urinary sphincter or male sling. Major surgery is the only option if people still remain substantially symptomatic.