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Urology. 2016 Feb;88:22-32. doi: 10.1016/j.urology.2015.11.006. Epub 2015 Nov 23.

The Relationship Between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review.

Author information

1
Division of Urology, Brigham and Women's Hospital, Boston, MA. Electronic address: mkathrins@bwh.harvard.edu.
2
Department of Surgery, Texas A&M Health Science Center College of Medicine, Temple, TX.
3
Department of Urology, University of Illinois at Chicago, Chicago, IL.
4
Division of Urology, Cooper Medical School of Rowan University, Camden, NJ.

Abstract

OBJECTIVE:

To systematically review prospective trials evaluating the clinical effects of testosterone-replacement therapy on lower urinary tract symptoms and prostate volume.

MATERIALS AND METHODS:

We performed a literature review through PubMed, Embase, and Cochrane Library from 1994 to 2015 for prospective trials of hypogonadal men with benign prostatic hyperplasia or lower urinary tract symptoms treated with testosterone-replacement therapy. We evaluated the abstracts for outcomes related to International Prostate Symptom Score, prostate volume, and urodynamic parameters.

RESULTS:

An original cohort of 3079 abstracts was reviewed. Thirty-five trials were selected for inclusion. The majority of trials reviewed found no significant prostate growth due to testosterone-replacement therapy. Studies of men with baseline mild lower urinary tract symptoms demonstrated either no change or an improvement in symptoms after treatment. There was a lack of relevant urodynamic studies. Trials of men with the metabolic syndrome demonstrated uniform improvement in lower urinary tract symptoms. Forty-six percent of all the trials identified included exclusion criteria for baseline severe-range lower urinary tract symptoms or other signs of obstructive lower urinary tract symptoms.

CONCLUSION:

The current literature demonstrates scant support for a causative relationship between testosterone-replacement therapy, de novo or worsening lower urinary tract symptoms, and prostate volume. Furthermore, our review found an absence of high quality evidence that would support guideline recommendations that testosterone-replacement therapy is relatively contraindicated in men with severe-range lower urinary tract symptoms. Future clinical trials with more inclusive voiding criteria are needed.

PMID:
26616095
DOI:
10.1016/j.urology.2015.11.006
[Indexed for MEDLINE]

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