Sarcouncil Journal of Medical Series

Abstract: It has been estimated that 50-80% of older adults have at least one bothersome urinary symptom, which is also referred to as 'lower urinary tract symptoms' (LUTS). The aim of this cross-sectional observational study was to assess the outpatient management of LUTS among 123 cardiovascular disease (CVD) patients aged 60 years and above. Between January 2024 and December 2025, 123 consecutive patients (78 males and 45 females, mean age of 71.4 years ± 7.2) with cardiac condition(s) and history of LUTS underwent recruitment from urology and cardiology outpatient clinics of a tertiary care hospital. For males, the International Prostate Symptom Score (IPSS) was used to assess the severity of LUTS; for females, the Overactive Bladder Symptom Score (OAB-SS) was used. Pharmacological treatments used to manage LUTS were noted, and patients were followed for 12 weeks for the presence of symptom response and cardiovascular adverse events. The mean IPSS at baseline was 19.7 ± 6.3 (moderate and severe) in males, and 8.9 ± 3.1 in females. Of the male patients, 62.8% received alpha-1 blockers, 28.2% received 5alpha-reductase inhibitors, 34.1% received antimuscarinics, and 18.7% received beta-3 agonists. Clinically significant symptom improvement (at least 3-point improvement on IPSS or 2-point improvement in OAB-SS) was seen in 67.5% of the patients after 12 weeks of treatment. Orthostatic hypotension was found in 14.6 % patients using alpha-1 blockers, and an increase in the QTc interval (more than 470ms in women and more than 450ms in men) was observed in 8.3 % of patients treated with antimuscarinics. Selecting drugs for medical management of LUTS in the older adult with cardiovascular disease is a fine art of balancing urological efficacy with cardiovascular safety. Antimuscarinics have the potential for prolonging the QTc interval and do require ECG monitoring in this population. Alpha-1 blockers are effective but pose a significant risk of orthostatic hypotension. The most favorable cardiovascular safety profile was seen for beta-3 agonists.