Guideline for the primary care management of male lower urinary tract symptoms

As my Comment in the first section of the journal suggested, the MTOPS results have offered the possibility to general practitioners of reducing the risk of side‐effects of BPH, particularly urinary retention, by giving patients dual therapy with 5α‐reductase inhibitor and alpha‐adrenergic blocker. Authors from the UK present guidelines for the primary case management of male LUTS, which significantly fills this gap in the literature. Any help in the management of chronic nonbacterial prostatitis is welcome to clinicians; many treatments have been proposed after non‐comparative trials, and so their value must be viewed cautiously. The authors from Canada and USA present the results of a randomized placebo‐controlled study into the use of finasteride in such patients. The other papers in this section all deal with LUTS, e.g. frequency and nocturia, in a variety of situations. There is still great interest in the epidemiology of these symptoms, and in the various methods of grading their severity.     

Prevalence of lower urinary tract symptoms and social determinants in primary care users in Brazil

Introduction and hypothesis

Although lower urinary tract symptoms (LUTS) have considerable clinical relevance, few propose evaluating its association with social conditions. Our study aimed to evaluate LUTS prevalence in primary care and its association with the social determinants of health (SDH).

Methods

This is a cross-sectional study conducted with 322 females in the period of June to October 2016 that carried out consultations and screening to prevent gynecological cancer in a primary care unit.

Results

The ages ranged from 18 to 85 years (M?=?40.53). Storage symptoms had a higher overall prevalence (64.6%), highlighting nocturia (n?=?186, 57.8%) and urinary incontinence (n?=?120, 37.3%). Storage symptoms were associated with three layers of SDH. The voiding and postmicturition symptoms were only related to operative vaginal delivery.

Conclusions

The findings of this study suggest a relationship between SDH and LUTS. It is important to emphasize that the results not only imply a causal relationship, but also point to the social inequalities existing at a population level.

     

Determinants of seeking of primary care for lower urinary tract symptoms: the Krimpen study in community-dwelling men

OBJECTIVES: To determine which factors predict seeking of primary care among men with lower urinary tract symptoms (LUTS). METHODS: A longitudinal, population-based study with a follow-up period of 6.5 yr was conducted among 1688 men aged 50-78 yr. The following data were collected: prostate volume (using transrectal ultrasonometry), urinary flow rate, ultrasound-estimated postvoid residual urine volume, generic and disease-specific quality of life (QOL), and symptom severity (International Prostate Symptom Score [IPSS]). Information on the seeking of primary care by all participants during 2 yr of follow-up was collected from the general practitioner's (GP) record using a computerised search engine and a manual check of electronically selected files. RESULTS: Prostate volume, postvoid residual volume, IPSS, and social generic QOL are important determinants of first GP consultation in men with LUTS. Measurements (physical urologic parameters) and self-reported items (symptom severity and QOL) contribute almost equally to GP consultation in these men. CONCLUSIONS: Both measurements of prostate volume and postvoid residual urine volume and self-reported information about symptoms or QOL can help to select those who will benefit from medical care and to reassure those men not likely to need help in the near future.     

Assessment of lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) encompass a range of symptoms commonly experienced by both men and women, and encountered by a wide range of healthcare practitioners (HCPs). This review summarizes the basic terminology and assessment that HCPs should be aware of, regardless of their professional discipline. Apart from emphasizing the need for standardization in terminology, there is a need to avoid misleading terms that suggest a causative mechanism until the mechanism has been identified by investigation. HCPs should also avoid arbitrary thresholds for judging severity of symptoms. The use of algorithms from evidence-based guidelines limits variation in management and avoids unnecessary investigations. However, a tailored approach is useful in understanding the underlying pathophysiology in individual patients. As symptoms are unreliable in predicting the underlying mechanism, a useful approach is to try and develop a urodynamic diagnosis mindful of the normal physiology of the lower urinary tract as the practitioner works through the symptoms, signs and appropriate urodynamic investigations, and use such investigations in a logical manner tailored to the individual to either support or refute assumptions and arrive at a working diagnosis.     

Assessment of lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) encompass a range of symptoms commonly experienced by both men and women. Discrepancies in interpretation require a standardized terminology, with an understanding of the different causations for each symptom. These should replace previous misleading words such as ‘prostatism’. The use of algorithms from evidence-based guidelines limits variations in management and avoids unnecessary investigations. Although symptoms do not predict the underlying pathophysiology, a useful approach is to try and develop a urodynamic diagnosis from the point of taking a history and using appropriate investigations in a logical, step-wise manner to arrive at a working diagnosis.     

Assessment of lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) encompass a range of symptoms commonly experienced by both men and women, and encountered by a wide range of healthcare practitioners (HCPs). This review summarizes the basic terminology and assessment that HCPs should be aware of, regardless of their professional discipline. Apart from emphasizing the need for standardization in terminology, there is a need to avoid misleading terms that suggest a causative mechanism until the mechanism has been identified by investigation. HCPs should also avoid arbitrary thresholds for judging severity of symptoms. The use of algorithms from evidence-based guidelines limits variation in management and avoids unnecessary investigations. However, a tailored approach is useful in understanding the underlying pathophysiology in individual patients. As symptoms are unreliable in predicting the underlying mechanism, a useful approach is to try and develop a urodynamic diagnosis mindful of the normal physiology of the lower urinary tract as the practitioner works through the symptoms, signs and appropriate urodynamic investigations, and use such investigations in a logical manner tailored to the individual to either support or refute assumptions and arrive at a working diagnosis.     

Sildenafil influences lower urinary tract symptoms

OBJECTIVE: To assess the possible relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED with sildenafil influences their LUTS. PATIENTS AND METHODS: In all, 112 men with ED attending the andrology outpatient clinic were offered oral sildenafil and reviewed 1 and 3 months after treatment. They completed the International Index of Erectile Function and the International Prostate Symptom Score (IPSS) questionnaires at baseline and each review. Scores were designated to indicate the visit number and differences between the visits calculated. RESULTS: A third of the men had an initial IPSS of > 7; there was no relationship between baseline urinary and sexual function scores. After treatment with sildenafil, the urinary scores at 3 months correlated strongly with the sexual function scores. There was a significant inverse relationship between the baseline IPSS and sexual function scores after treatment. The overall trend in the IPSS was towards improvement after treatment with sildenafil. CONCLUSIONS: In men with ED there is no relationship between sexual function scores and urinary symptom scores before treating ED. Treatment with sildenafil appears to improve urinary symptom scores. A lower IPSS at baseline appears to predict a better response to ED therapy with sildenafil.     

Sexual activity and lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) have a profound impact on womens physical, social, and sexual well being. The LUTS are likely to affect sexual activity. Conversely, sexual activity may affect the occurrence of LUTS. The aims of the study were to elucidate to which extent LUTS affect sexual function and to which extent sexual function affect LUTS in an unselected population of middle-aged women in 1 year. A questionnaire was sent to 4,000 unselected women aged 40–60 years. All 2,284 women (57.1%) who completed a baseline questionnaire and a similar questionnaire 1-year later were included. Data comprised age, occurrence of LUTS, hormonal status, and sexual activity. A multiple conditional logistic regression model was used to analyze the relationship between sexual activity and LUTS adjusted for age and hormonal status. At baseline and 1-year later, 49 women (2.2%) had no sexual intercourse, and 298 women (13.0%) either ceased or resumed sexual relationship. Compared to women having sexual relationship, a statistically significant three to sixfold higher prevalence of LUTS was observed in women with no sexual relationship. In women who ceased sexual relationship an increase, although not statistically significant, in the de novo occurrence of most LUTS was observed. In women who resumed sexual relationship an insignificantly decrease in LUTS was observed. In women whose sexual activity was unchanged no change in the occurrence of LUTS was observed. Our study confirms a close association between sexual activity and the occurrence of LUTS. A hypothesis that sexual inactivity may lead to LUTS and vice versa cannot be rejected.     

The medical management of lower urinary tract symptoms and benign prostatic hyperplasia

Prostatism is a widely used term assigned to the symptom complex of older men with voiding dysfunction. The cause of the syndrome has routinely been ascribed to an enlarged prostate. More recent thinking recognizes that many men with such symptoms do not, in fact, have prostate enlargement or benign prostatic hyperplasia (BPH) and that such symptoms are not a surrogate for BPH. Such recognition is essential if cost effective medical management of lower urinary tract symptoms (LUTS) is to be achieved. Prostate volume has emerged as a key factor in the selection of medical therapy of LUTS and BPH not only regarding symptom relief but also to the newer concept of the prevention of disease progression and the avoidance of future adverse events in those men with true BPH. In the United States, medical management is now first line therapy for LUTS. The proper selection of therapy based on the patient's individual pathophysiologic characteristics is now made possible by many new recent studies within the medical literature.     

Ejaculatory disorders and lower urinary tract symptoms

A growing body of literature supports the observed association between lower urinary tract symptoms and sexual dysfunction. The causal relationship between these two conditions has not been determined. Ejaculatory function is an important aspect of sexual functioning and recent studies have shown a high prevalence of this ejaculatory dysfunction in men with lower urinary tract symptoms. Furthermore, the degree of bother associated with ejaculatory dysfunction is quite high, making it an important problem for patients. Thus, health care providers should have a heightened sense of awareness for the presence of ejaculatory dysfunction and appropriate patient counseling should be undertaken before initiation of specific treatments for lower urinary tract symptoms.     

Medical management of lower urinary tract symptoms in men: current treatment and future approaches

Lower urinary tract symptoms (LUTS) are extremely common in men and, in addition to causing considerable bother, can lead to the development of complications, such as acute urinary retention. Over the past couple of decades, developments in the medical management of LUTS in men have led to a substantial decline in the number of surgical procedures being performed to treat associated disorders, such as prostatectomy for benign prostatic enlargement. In this Review we summarize the available treatments and discuss the latest data on the use of anticholinergics and phosphodiesterase type-5 inhibitors for this indication. We also review the various combinations of medical therapies that have been reported in the literature to optimize the management of LUTS in men. In addition, there is a growing realization that LUTS in men are not synonymous with prostatic disease, and in many patients overactive bladder syndrome is the cause or a component of the LUTS experienced; we have, therefore, taken the opportunity to try to clarify the terminology used in LUTS in men, since there is the potential for considerable confusion with the terms that are currently in common usage in any discussion of this disorder.     

Male lower urinary tract symptoms and related health care seeking in Germany.

OBJECTIVES: To investigate the prevalence of lower urinary tract symptoms (LUTS) and LUTS- related health care issues in the male population between the ages of 50 and 80 in Germany. METHODS: 8,973 randomly chosen men in the age group of interest received by mail a self-administered questionnaire addressing voiding symptoms and bother, common health status, and social demographic as well as health care resources related issues. RESULTS: Of 6,031 (67.2%) returned questionnaires, 5,404 (60.2%) were properly filled out and entered into the database. Of these, 5,004 (56%) completed all IPSS questions. 3,539 (70.7%) of the men presented with no or mild LUTS (IPSS 0--7), 1,465 (29,3%) with moderate to severe voiding symptoms (IPSS >7), respectively. From logistic regression analysis it appears that mainly bother from voiding symptoms as well as incomplete emptying and week stream induced a visit to the doctor. Of men with moderate symptoms (IPSS 8--19), 40% did not report any bother. CONCLUSION: LUTS is a common condition among German elderly males. In general, bother from LUTS seem to have more effects on health care seeking behavior than symptoms themselves or physical health status. Bother scores may discriminate between those individuals with moderate symptoms (IPSS 8--19), who may be followed through watchful waiting instead of active therapy.     

Evolution of healthcare costs for lower urinary tract symptoms associated with benign prostatic hyperplasia

International Urology and Nephrology - With the ubiquity of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in older men, costs related to this highly prevalent disease...     

Current pharmacotherapy of lower urinary tract symptoms

Lower urinary symptoms (LUTS), including the overactive bladder (OAB) syndrome, can be found in 10–15% of all men and women and often have major effects on quality of life and social functioning. The first line of pharmacological treatment of OAB in women has been and still is antimuscarinic drugs. In men α₁-adrenoceptor (AR) antagonists remain the standard treatment of LUTS. However, recent advances in the physiology/pathophysiology of LUTS/OAB, recognizing the functional contribution of the urothelium, the spontaneous myocyte activity during bladder filling, and the diversity of nerve transmitters involved, have sparked interest in novel possibilities to treat these conditions. For example, new, selective α₁-AR antagonists (naftopidil, silodosin), β₃-AR agonists (mirabegron), phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil), combinations (α₁-AR antagonist + antimuscarinic), and drugs with a central mode of action (duloxetine, tramadol) all have positive proof of concept documented in randomized, controlled trials. Which of these therapeutic principles will be developed as clinically useful treatments remains to be established.     

女性下尿路症状调查

目的　调查城市社区女性下尿路症状的发病情况。　方法　采用自我完成的问卷调查,问卷的大部分内容参考BFLUTS问卷,并根据国内具体情况进行调整。社区妇幼保健人员逐户入户调查发卷和收卷,并指导填写。　结果　调查共发出问卷 6066份,回收 5587份。答卷者中>18岁者4745人。其中压力性尿失禁、急迫性尿失禁、尿急、尿频、夜尿的患病数分别为 425例 (9. 0% )、113例(2. 4% )、489例(10. 3% )、72例(1. 5% )、446例 (9. 8% )。总贮尿症状患病率随着年龄增加而增加, 18~27岁患病率为 20. 5% (104 /507), 28~37岁患病率为 19. 1% (332 /1740), 38~47岁患病率为22. 5% (338 /1503), 48 ~57岁患病率为 32. 2% ( 202 /628 ), 58 ~64岁患病率为 41. 2% ( 61 /148 ),65岁以上者发患率为 58. 0% (127 /219),总患病率为 24. 5%。排尿延迟、排尿中断、增加腹压排尿、不能完全排空膀胱、排尿疼痛等症状的患病率分别为 7. 0% ( 330例 )、4. 1% ( 194例 )、4. 6% ( 217例)、4. 9% (233例)、4. 8% (229例)。总排尿症状患病率随着年龄增加而增加, 18 ~27岁患病率为13. 0% (66 /507), 28~37岁患病率为 9. 3% (162 /1740), 38~47岁患病率为 10. 7% (161 /1503), 48~57岁患病率为 13. 2% (83 /628), 58~64岁患病率为 16. 2%