Implications of recent epidemiology studies for the clinical management of lower urinary tract symptoms

Kaplan, Steven A.; Roehrborn, Claus G.; Chapple, Christopher R.; Rosen, Raymond C.; Irwin, Debra E.; Kopp, Zoë; Aiyer, Lalitha Padmanabhan; Mollon, Patrick

doi:10.1111/j.1464-410x.2009.08372.x

Cited by 27 publications

(19 citation statements)

References 59 publications

(88 reference statements)

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“…Documented barriers to seeking help for LUTS include feeling too embarrassed, ashamed, or uncomfortable to talk with a doctor about urinary symptoms (Doshani, Pitchforth, Mayne, & Tincello, 2007; Nicolson et al, 2008), lack of awareness that symptoms are treatable (Diokno, Sand, Macdiarmid, Shah, & Armstrong, 2006; Horrocks, Somerset, Stoddart, & Peters, 2004; Shaw, Tansey, Jackson, Hyde, & Allan, 2001), and uncertainty about the cause of the symptoms (Gannon, Glover, O'Neill, & Emberton, 2004). As expected, higher levels of perceived symptom severity and bother increase the likelihood of help-seeking (Kaplan et al, 2009; Sandvik, Kveine, & Hunskaar, 1993; Sarma, Wallner, Jacobsen, Dunn, & Wei, 2008; Shaw et al, 2001). However, among those people who reported experiencing multiple LUTS, less than one-third sought medical care (Sexton et al, 2009).…”

Section: The Case Of Lower Urinary Tract Symptomssupporting

confidence: 67%

Race and Ethnic Differences in Health Beliefs About Lower Urinary Tract Symptoms

Welch

Botelho²,

Tennstedt³

2011

Nursing Research

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Background Health beliefs are an important mediator between the experience of symptoms and health behaviors, and these beliefs can vary by race or ethnicity. Objectives To better understand the gap between experiencing symptoms and not seeking medical care by studying health beliefs about lower urinary tract symptoms (LUTS) across race and ethnic groups. Method Qualitative, semistructured interviews were conducted with 35 Black, Hispanic, and White people who reported at least one urinary symptom but had not spoken with a health care provider about the symptoms. Drawing on Shaw’s framework of health behavior and outcomes, a range of beliefs was examined: cause, consequence, continuation, and treatability. Interviews were transcribed, coded, and analyzed for themes according to race or ethnic background. Results The belief that LUTS are a typical part of aging and not amenable to medical treatment was most common among White respondents. Black respondents more commonly attributed their symptoms to personal behaviors over which they had control and therefore did not require medical care. Hispanic respondents appeared more often to live with uncertainty about the cause of their symptoms and an accompanying concern about a future health consequence. Discussion The combination of a range of health beliefs to form a cognitive representation made sense of the behavior of not seeking medical care. The finding that sociocultural differences shaped these cognitive representations underscores the need for cultural competency in patient assessment and education. Results have implications for theories of health behavior and indicate further research with larger samples, additional psychosocial influences, and other symptoms.

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Section: The Case Of Lower Urinary Tract Symptomssupporting

confidence: 67%

Race and Ethnic Differences in Health Beliefs About Lower Urinary Tract Symptoms

Welch

Botelho²,

Tennstedt³

2011

Nursing Research

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“…Of note, the IPSS is somewhat biased toward voiding symptoms, as four of the seven question belong to the voiding sub-score. While a pathophysiological link between BPH and the associated obstruction and lower urinary tract symptoms (LUTS) implies mainly the presence of voiding/obstructive symptoms, storage/irritative symptoms are also common in such men [2]. …”

Section: Introductionmentioning

confidence: 99%

Role of voiding and storage symptoms for the quality of life before and after treatment in men with voiding dysfunction

et al. 2009

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PurposePrevious studies on associations between voiding dysfunction and quality of life (QoL) have largely been limited to baseline data. Therefore, we have explored associations between Qmax and voiding and storage sub-scores of the International Prostate Symptom Score (IPSS) before and after treatment with QoL.MethodsAnalysis of a single-center database of 2,316 men with voiding dysfunction attributed to benign prostatic hyperplasia undergoing various medical and surgical treatment forms.ResultsQmax exhibited little correlation with QoL before or after treatment. IPSS inversely correlated with QoL at baseline and after treatment, and IPSS improvements correlated with those of QoL. The associations applied to both the voiding and storage sub-score of the IPSS, with the latter consistently exhibiting somewhat tighter associations.ConclusionsOur post-treatment data support the idea of a cause–effect relationship between voiding symptoms and QoL irrespective of treatment form. While both voiding and storage symptoms contribute to this relationship, storage symptoms play a somewhat greater role.

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“…However, more than 40% of men have a significant storage component to their symptoms and 16% exhibit symptoms of an overactive bladder. 1 and 2 This suggests that anticholinergics may have a role in symptom amelioration in certain men with BPH/LUTS.…”

mentioning

confidence: 99%

The Efficacy and Safety of Combined Therapy with α-Blockers and Anticholinergics for Men with Benign Prostatic Hyperplasia: A Meta-Analysis

et al. 2013

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Purpose We performed a meta-analysis to compare treatment with α-blockers and anticholinergics (ie combination therapy) to α-blocker monotherapy to clarify the efficacy and safety of this treatment approach among men with storage urinary symptoms related to benign prostatic hyperplasia. Materials and Methods We searched for trials of men with benign prostatic hyperplasia/lower urinary tract symptoms that were randomized to combination treatment or α-blockers alone. We pooled data from 7 placebo controlled trials meeting inclusion criteria. Primary outcomes of interest included changes in International Prostate Symptom Score (storage subscores) and urinary frequency. We also assessed post-void residual volume, maximal flow rate and the incidence of urinary retention. Data were pooled using random effects models for continuous outcomes and the Peto method to generate odds ratios for acute urinary retention. Results Combination therapy had a significantly greater reduction in International Prostate Symptom Score storage subscores (Δ −0.73, 95% CI −1.09 – −0.37) and voiding frequency (Δ −0.69 voids, 95% CI −0.97 – −0.41). There was also a greater reduction in maximal urinary flow rate (Δ −0.59 ml per second, 95% CI −1.04 – −0.14) and increase in post-void residual urine volume (Δ 11.60 ml, 95% CI 8.50–14.70) with combination therapy. The number needed to treat with combination therapy to cause 1 acute urinary retention episode was 101 (95% CI 60–267). Conclusions Combination treatment with α-blockers and anticholinergics significantly improved storage voiding parameters compared to men treated with α-blocker therapy alone. This treatment approach is safe with a minimal risk of increased post-void residual urine volume, decreased maximal urinary flow rate or acute urinary retention.

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Implications of recent epidemiology studies for the clinical management of lower urinary tract symptoms

Cited by 27 publications

References 59 publications

Race and Ethnic Differences in Health Beliefs About Lower Urinary Tract Symptoms

Race and Ethnic Differences in Health Beliefs About Lower Urinary Tract Symptoms

Role of voiding and storage symptoms for the quality of life before and after treatment in men with voiding dysfunction

The Efficacy and Safety of Combined Therapy with α-Blockers and Anticholinergics for Men with Benign Prostatic Hyperplasia: A Meta-Analysis

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