90% of men with LUTS do not undergo treatment

More than 90% of men whose lower urinary tract symptoms (LUTS) progress do not seek treatment for their symptoms, according to recent study results that one expert cautioned against overinterpreting.

Study authors, from Kaiser Permanente in California, say men who do not seek care may be good candidates for a self-management plan. Their findings were published in BJU International (2015; 115:127-33).

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Researchers followed more than 39,000 men aged 45 to 69 years for 4 years, conducting patient surveys in 2002-2003 and again in 2006-2007. Men who completed both surveys who did not have a diagnosis of BPH and were not receiving medical therapy for LUTS were included in the study. Study patients were from racially diverse backgrounds.

Among the men with no or mild symptoms at baseline, the incidence of moderate/severe LUTS (AUA Symptom Index [SI] score ≥8) and odds of progression to severe LUTS (AUA SI score ≥20) was estimated during 4 years of follow-up.

Of the nearly 10,000 men who reported no/mild LUTS at baseline, 41% reported moderate/severe symptoms at follow-up and experienced a mean 4-point change in AUA SI score. Of these men, 91% had no treatment recorded, 8.8% had received drug therapy, and 0.2% had undergone a minimally invasive or surgical procedure. Men who progressed to severe symptoms were more likely to be on medication for BPH, have a BPH diagnosis, or have seen a urologist than were men who did not progress to severe symptoms.

“In the present multi-ethnic cohort of men aged 45-69 years, although 41% developed moderate/severe LUTS over 4 years of follow-up, <10% of these men received surgical or drug therapy for their symptoms,” wrote the authors, led by Steven J. Jacobsen, MD, PhD, of Kaiser Permanente in Pasadena, CA. “As expected, treatment was more common among men who progressed to severe LUTS, but was still suboptimal.

The data show that the majority of men who experienced LUTS progression did not receive medical or surgical therapy “and, therefore, may prove to be good candidates for a self-management plan,” they added.

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According to a Kaiser statement, plans are underway at Kaiser Permanente Southern California to launch a web-based self-management program for men with LUTS. “The innovative program would allow men to take control of their LUTS symptoms and possibly prolong the start of drug or surgical treatment,” the statement said.

Steven A. Kaplan, MD, of Weill Cornell Medical College in New York, called the study interesting, but urged urologists not to overinterpret the results.

“These results illustrate the challenges of interpreting population-based behaviors and their root causes,” said Dr. Kaplan, a member of the Urology Times Editorial Council, who was not involved in the study. “Using a 4-point change in AUA symptom score (defined in a large clinical study), while well established, does not necessarily reflect real-world behavior.”

Such methodology, he said, does not reflect whether “bother” from patients’ symptoms progressed; whether the patient and/or health care provider were aware of treatment options and discussed them; and analyzes the quantity of symptoms but not the quality, ie, symptom progression on nocturia or frequency may be more important than symptom progression related to the strength of urinary stream.

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