Effectiveness of a Treatment Protocol for Lower Urinary Tract Symptoms in General Practice
Effectiveness of a Treatment Protocol for Lower Urinary Tract Symptoms in General Practice
Ageing and the availability of medication has led to an increase of elderly male patients
 being treated for lower urinary tract symptoms (LUTS), or voiding problems ("prostate
 problems"). However, guidelines are vague as to which patients should and which should not be
 treated, and how.

 Although several treatment modalities have proven efficacy in selected populations, it is
 unclear how effective these treatments are in daily practice.

 This study investigates the hypothesis that a treatment protocol in which clear indications
 are formulated for all treatment modalities is more effective, as compared to current usual
 primary care, in reducing both symptoms as related to the quality of voiding in elderly
 males.
Guidelines fail to provide specific diagnostic criteria and clear indications for therapy in
 elderly male patients with lower urinary tract symptoms. Consequently, the group of patients
 diagnosed with LUTS in primary care is very heterogeneous, and daily care varies widely.

 Consequently, efficacy trials of alpha-blockers, 5-alpha-reductase inhibitors and surgery
 performed in selected, well defined homogeneous populations cannot easily be generalised to
 the heterogeneous primary care situation.

 A practical randomised trial enrolling patients on the basis of symptoms have the advantage
 of being of immediate practical value.

 We compare a treatment protocol with clear indications for therapy with current usual care in
 a population selected on symptoms rather than well defined diseases or definite test results.

 Two hundred eight subjects were randomised into intervention (N=104) and control (N=104)
 conditions.

 After two years of follow-up, IPSS scores, bother scores, maximum urinary flow rates and the
 incidence of acute urinary retention and urinary tract infections have been compared.
Inclusion Criteria:

 -  International Prostate Symptom Score > 7

 -  Age > 55 years

 Exclusion Criteria:

 -  Heart failure

 -  Diabetes type I

 -  Psychiatric disorder/cognitive dysfunction

 -  History of prostate surgery

 -  Active treatment for lower urinary tract symptoms