Office evaluation of men with lower urinary tract symptoms

The benign prostatic hyperplasia registry and patient survey: study design, methods and patient baseline characteristics

OBJECTIVE

To describe the design and baseline cohort characteristics of the Benign Prostatic Hyperplasia (BPH) Registry and Patient Survey, an ongoing, prospective, observational, disease registry documenting management practices and patient outcomes in men in the USA with lower urinary tract symptoms associated with BPH (LUTS/BPH) in actual clinical practice settings.

PATIENTS AND METHODS

Men with LUTS/BPH who were either untreated or treated with alpha(1)-adrenergic blockers (ABs), 5alpha-reductase inhibitors (5ARIs), a combination of these medications, or anticholinergics, and who met selection criteria, were enrolled at sites throughout the USA. At each visit, standardized forms and validated questionnaires were completed to assess the physicians' management practices and patients' clinical characteristics, sexual function, and health-related quality of life.

RESULTS

At the close of recruitment (February 2005), 6909 men (mean age 66.0 years) were enrolled at 402 sites by urologists and primary-care physicians. Before enrolment, 49% of the men were managed with watchful waiting (WW), 21% with uroselective AB monotherapy, 11% with non-uroselective AB monotherapy, 6% with 5ARI monotherapy, 11% with AB + 5ARI, and 2% with anticholinergics. After enrolment, 42% were on WW and 26% were on selective AB monotherapy; changes in other management groups were minimal. Overall, 33% of the men had mild, 52% had moderate and 15% had severe LUTS. The most common comorbidities were hypertension (53%), high cholesterol (45%) and sexual dysfunction (36%).

CONCLUSION

The BPH Registry and Patient Survey will provide information on physician management practices and outcomes of men with LUTS/BPH, while examining the effects of demographics, socio-economics, comorbidities, and medical therapies.

Benign Prostatic Hyperplasia in Primary Care: What You Need to Know

PURPOSE

We reviewed recent literature and treatment guidelines regarding the prevalence, pathophysiology, and management of BPO related to BPH; and management of lower urinary tract symptoms secondary to BPH.

MATERIALS AND METHODS

Published literature and current treatment concepts were reviewed regarding the diagnosis and treatment options for BPO.

RESULTS

BPH is a histological diagnosis that can contribute to medical problems, including enlargement of the prostate and BPO. These conditions should be treated only if the symptoms are troublesome, there is considerable risk of progression, and/or cancer is suspected. Very effective medical and surgical options are available to treat BPO and improve patient quality of life.

CONCLUSIONS

BPO is highly treatable, but should be managed in close collaboration with the patient. Pharmacological agents and minimally invasive procedures, when appropriate, are generally preferred to more invasive surgery. Patients with mild or moderate symptoms usually can be treated by a primary care physician; more complicated cases should be referred to a urologist for evaluation and management.

Mode of administration of international prostate symptom score in patients with lower urinary tract symptoms: physician vs self

International prostate symptom score (IPSS) was claimed to be complicated for patients. The aim of this study was to measure differences in IPSS when introduced by a physician vs self-administration. Patients with lower urinary tract symptoms completed two IPSS questionnaires: one self-administrated and the other by a physician 1 week apart. Results with 75 patients in each group suggested that there was no statistically significant difference between patient and physician administration, although the mean scores of patients' administration were higher in both groups. In conclusion, when assessing IPSS before treatment, we found no difference between patient administration and physician administration.

Diagnosis and treatment of voiding symptoms

Lower urinary tract symptoms (LUTS) are associated with lower urinary tract dysfunction. Symptoms are the subjective indicator of a disease or change in condition as perceived by the patient, caregiver, or partner and may lead the individual to seek help from health care professionals. LUTS are usually qualitative and, therefore, cannot usually be used to make a definitive diagnosis. LUTS also can indicate pathologies other than lower urinary tract dysfunction, such as urinary infection. LUTS are divided into 7 groups: storage, voiding (obstructive), postmicturition symptoms and 4 others. Voiding symptoms, which are caused by lower urinary tract obstruction, include slow stream, splitting or spraying, intermittency, hesitancy, straining, and terminal dribble. Postmicturition symptoms, which are experienced immediately after micturition, consist of the feeling of incomplete emptying and postmicturition dribble. Postmicturition dribble describes the involuntary loss of urine immediately after the individual has finished passing urine; in men, usually after leaving the toilet and in women, after rising from the toilet. Hence, postmicturition dribble is elicited by different situations or is considered as having different implications. For example, although postmicturition dribble usually implies incomplete emptying (voiding symptoms) in elderly men with benign prostatic hyperplasia, postmicturition dribble is often considered as urinary incontinence (a storage symptom) in many patients, even with bladder outlet obstruction. In such cases, detailed history taking and further evaluation, such as urinary flowmetry, postvoid residual volume, and comprehensive urodynamic evaluation, should be performed as appropriate. If no urodynamic abnormalities of either the detrusor or the outlet can be detected despite significant LUTS, factors unrelated to the lower urinary tract may be responsible for the voiding symptoms.

The efficacy of an abbreviated model of the International Prostate Symptom Score in evaluating benign prostatic hyperplasia

OBJECTIVES

To investigate the acceptability to patients in Turkey of the International Prostate Symptom Score (IPSS) for evaluating benign prostatic hyperplasia (BPH), and to devise a possible abbreviated model, saving time when administered by a physician.

PATIENTS AND METHODS

The IPSS questionnaire was initially self-administered in 200 consecutive patients aged> 50 years and with lower urinary tract symptoms. Patients were instructed only to mark questions which they clearly understood. The IPSS was then administered to 500 consecutive patients by the same physician. Subsequently, each of the seven questions was separately correlated with the IPSS and quality-of-life (QoL) score. The first five questions with the highest correlation coefficient for both the total IPSS and QoL score were identified, and every possible combination of these questions produced and correlated.

RESULTS

In the first group, 29% of the patients did not complete the form and 44% could not mark at least one item; the effect of educational level was significant (P < 0.05). In the second group a combination of the first three items had a Pearson's correlation of 0.90 with the total IPSS; similarly, four questions combined (2, 3, 6 and 7) also correlated well (r = 0.92). Both combinations took significantly less time to administer (P < 0.05).

CONCLUSION

The abbreviated form of the IPSS consisting of three or four items may be used to assess symptoms in patients with BPH, especially in underdeveloped countries.

Diagnosis and management of chronic prostatitis by primary care providers

PURPOSE

To describe the etiology, clinical manifestations, differential diagnosis, and treatment of chronic bacterial and chronic abacterial prostatitis (CBP and CAP respectively) in the primary care setting.

DATA SOURCES

Selected research, clinical guidelines, and research-based articles in the scientific literature.

CONCLUSIONS

Most cases of CBP can be appropriately diagnosed and treated in the primary care office. In the case of a diagnosis of CAP, initial therapy can be started by the nurse practitioner (NP) with referral to a urologist for refractory cases.

IMPLICATIONS FOR PRACTICE

Complete eradication of pathogens in CBP is not always possible. Assisting patients to carefully follow their treatment regimens, including completion of all antibiotic therapy, will reduce the frequency and severity of symptoms. Successful management of chronic prostatitis symptoms can result in an improved quality of life and an increased ability to perform activities of daily living for patients. Chronic abacterial prostatitis may require referral to a urologist or mental health professional for co-management of symptoms.