The American Urological Association Symptom Score in the Evaluation of Men With Lower Urinary Tract Symptoms: at 2 years of followup, does it work?

Purpose

The American Urological Association (AUA) benign prostatic hyperplasia (BPH) guidelines committee established criteria for the diagnosis and treatment of patients BPH. In a prospective study we determined the usefulness of these guidelines in 145 previously untreated patients with BPH symptoms.

Materials and Methods

Patients were evaluated initially by AUA symptom score, digital rectal examination, urinalysis, serum creatinine and prostate specific antigen. Based on symptom score, patients with mild symptoms were treated with watchful waiting, while those with moderate and severe symptoms were offered watchful waiting, finasteride alpha-blockers, or laser or transurethral prostatectomy. Minimum followup was 2 years. Patients were offered a change in therapy if they had an intolerable adverse event or no improvement. Analysis included maintenance of therapy at 1 and 2 years, number of office visits and diagnostic tests performed. In addition, all patients were queried regarding which factors influenced their therapeutic choice.

Results

Of 37 patients with mild symptoms 31 (81 percent) remained on watchful waiting at 2 years and 6 advanced to medical therapy. Among 71 patients with moderate symptoms 9 of 15 (60 percent) remained on watchful waiting, 27 of 36 (75 percent) remained on alpha-blockers and 12 of 20 (60 percent) remained on finasteride at 2 years. Of the 37 patients with severe symptoms 1 of 5 (20 percent) remained on watchful waiting, 1 of 6 (17 percent) remained on finasteride and 9 of 15 (60 percent) remained on alpha-blockers, while 3 of 5 (60 percent) who underwent laser prostatectomy and all 6 (100 percent) who underwent transurethral prostatectomy received no further treatment. At 2 years 83 percent of the men who selected either finasteride or alpha-blockers as either the primary or secondary therapeutic choice were still on medications. Most patients with mild (61 percent) or moderate (51 percent) symptoms cited adverse events as the predominant concern when selecting therapeutic options. In contrast, efficacy was the overriding concern (70 percent) in patients with more severe symptoms.

Conclusions

Overall, with these guidelines and the AUA symptom score 110 men (76 percent) were still on original therapy at 1 year and 99 (68 percent) at 2 years. Additionally, 31 patients (21 percent) changed to an alternative, nonoperative therapy. These results suggest that the AUA BPH guidelines provide a rational and balanced approach for evaluation and management of patients with symptomatic BPH. Patients can reasonably expect to remain on the initial therapeutic option for at least 2 years.     

Urinary Incontinence,Overactive Bladder,and Other Lower Urinary Tract Symptoms: A Longitudinal Population-Based Survey in Men Aged 45–103 Years

Background

Lower urinary tract symptoms (LUTS) such as urinary incontinence (UI) and overactive bladder (OAB) are highly prevalent conditions, but there are few studies describing progression and remission of LUTS in men, especially over the long term.

Objective

To describe the prevalence of UI, OAB, and LUTS using current International Continence Society definitions in the same men studied longitudinally over time.

Design

Prospective, population-based, longitudinal study.

Setting and participants

In 1992, 10 458 men aged 45–99 yr, resident in the city of Gothenburg, were selected at random from the Population Register.

Measurements

The men received a postal questionnaire about the presence of LUTS, as well as questions on social, medical, health-related quality of life (HRQoL), and demographic data. Responders in 1992 were reassessed 11 yr later in 2003 using a similar questionnaire.

Results and limitations

In 2003, 4072 of the 7763 men who responded in 1992 were still available in the Population Register and 3257 men (80%) aged 56–103 yr, responded. Prevalence of UI and OAB had increased (p < 0.01) in the same men assessed in 1992 (4.5% and 15.6%, respectively) and 2003 (10.5% and 44.4%, respectively). The prevalence of nocturia, urgency, slow stream, hesitancy, incomplete emptying, postmicturition dribble, and the number of daytime micturitions had also increased (p < 0.01). Only a minority reported regression of symptoms. Men with UI or OAB reported a poorer (p < 0.001) HRQoL compared with men without UI or OAB.

Conclusions

There was a marked increase in the prevalence of UI, OAB, and other LUTS in the same men assessed longitudinally over this 11-yr period. UI and OAB had a negative influence on HRQoL, and men who developed UI or OAB had a greater deterioration in HRQoL than men who had no change in their UI/OAB status over time.