Elderly Men with an Overactive Bladder in Combination with Infravesicular Obstruction (Literature review)

Overactive bladder (OAB) combined with infravesicular obstruction (IVO) is one of the most common causes of lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia (BPH), as the main cause of IVO in elderly men, is one of the most common urological diseases, causing urinary problems in every second man aged 60 years and older. According to many authors, the incidence of OAB increases from 3% in men aged 40–44 years to 42% in men over 75 years. LUTS in BPH are usually divided into: storage symptoms, voiding symptoms and post- voiding symptoms. Although voiding symptoms are somewhat more common, storage symptoms are significantly more bothersome to patients, which directly correlates with their quality of life. In such conditions, adjusting the strategy and tactics of managing this category of patients is justified. Given the widespread prevalence of combined urological pathology among the male population due to its rapid aging in our country, achieving the desired health improvement requires new approaches and principles in diagnosis and treatment. Urodynamic study (UDS) is the only method of examination that allows reliable diagnosis of IVO and OAB. Including the results of the “pressure-flow” study in the general preoperative examination algorithm significantly reduces the frequency of subjective failures compared to the past, when patient selection for surgical treatment was carried out without considering urodynamic parameters. A review of the literature indicates that there are currently a number of questions that arise when attempting to predict treatment effectiveness. Most previous methods and studies used univariate analysis, which considered a single factor independently of other variables. However, in modern conditions, it is necessary to take into account a set of parameters that can significantly affect predictions (severity and duration of bladder storage and voiding symptoms, UDS data, OAB questionnaire data, etc.). Some of these factors can only be studied under experimental conditions. This includes the degree of OAB, the type of overactivity, the severity of IVO, and the effectiveness of medical and surgical treatment. This situation dictates the need to create a universal methodology that would provide positive treatment results with a high degree of probability.