Moderate-to-Severe Lower Urinary Tract Symptoms (LUTS) Undertreated

Only 10% of those who progress from no or mild to moderate or severe LUTS are treated.
Only 10% of those who progress from no or mild to moderate or severe LUTS are treated.

Only about 1 in 10 men aged 45-69 years who progress from no or mild lower urinary tract symptoms (LUTS) to moderate or severe LUTS receive pharmacologic or minimally invasive or surgical treatment, a study found.

The study, led by Lauren P. Wallner, PhD, MPH, of the University of Michigan in Ann Arbor, included 19,505 men enrolled in the Southern California Kaiser Permanente Health Plan. The men had answered survey questionnaires in 2002-2003 and 2006-2007 and at baseline did not have a diagnosis of benign prostatic hyperplasia (BPH) and were not on medication for LUTS at baseline.

Of the 9,640 men who reported no or mild LUTS at baseline, 3,993 (41%) reported moderate or severe symptoms after 4 years of follow-up, having experienced at least a 4-point increase in American Urological Association Symptom Index (AUASI) score. Of these patients, 351 (8.8% had received a pharmacologic treatment and 8 (0.2%) had undergone a minimally invasive or surgical procedure, Dr. Wallner and her colleagues reported online ahead of print in BJU International.

Among individuals who had severe LUTS at baseline, 51.8% experienced at least a 4-point decrease in AUASI score.

Additionally, study results showed that the 165 men who progressed to severe symptoms (AUASI score of 20 or higher) were 8.0 times more likely to be on medication for BPH, 4.7 times more likely to have a BPH diagnosis, and 2.5 times more likely to have seen a urologist than men who did not progress to severe symptoms (AUASI score less than 20).

“The present results support the notion that LUTS is a dynamic condition,” the authors wrote. “While a significant proportion of men experienced worsening symptoms during follow-up, a subset of men in the present study saw improvement in their symptoms over the 4-year follow-up.”

Dr. Wallner's group commented that their study suggest that a sizeable population of men experience new-onset moderate to severe LUTS within 4 years and therefore may be appropriate candidates for a self-management program to manage their symptoms, to prolong the start of drug or surgical treatment, or both.

The researchers cited a study published in the British Medical Journal (2007;334:25) in which researchers in London concluded that a self-management program has the potential to be an ideal first-line treatment for men with uncomplicated LUTS. The study included 140 men referred by general practitioners to outpatient urology departments. Researchers randomized 67 patients to receive standard care alone and 73 to receive standard care and to take part in a self-management program. The self-management group participated in 3 small group sessions that incorporated education, lifestyle advice, and training in problem solving and goal setting skills. At 12 months, 31% of the self-management group experienced treatment failure—the primary outcome measure of the study—compared with 79% of the standard care only group.

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