Latest Developments in the Assessment and Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: What is Clinically Relevant?

Abstract

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are prevalent and increase with aging. Epidemiological studies have shown that approximately 40 % of men aged C50 years have bothersome LUTS/BPH [1]. It is therefore not surprising that LUTS/BPH are positioned at 7th place in the most frequently diagnosed and most costly diseases in men aged C50 years [2]. Healthcare-seeking behavior is triggered by LUTS severity and LUTS phenotypes. Men often consult their doctors when they have severe LUTS or experience urinary urgency or nocturia [1,3]. LUTS/BPH have a multifactorial etiology and can be caused by the prostate, bladder, urethra, pelvic floor, central or peripheral nervous system, ureters, or even by the kidneys in case of nocturnal polyuria [4]. LUTS can be divided into storage (e.g., urgency, frequency, nocturia), voiding (e.g., hesitancy, poor stream, intermittency), and post-micturition symptoms (post-void dribbling, feeling of incomplete bladder emptying) [5].The majority of guidelines on LUTS/BPH have been established by urologists [4,6,7] but can also be-more or less easily-implemented by other medical specialties. Different healthcare systems worldwide have different regulations and defined responsibilities regarding which medical specialty should primarily assess and treat men with LUTS/BPH. While almost three-quarters of men with LUTS/BPH in Germany are diagnosed and treated by urologists [8], the majority of men in other countries, for example Australia or the UK, are managed by primary-care physicians. Specialized training programs and experience with patients with LUTS/BPH are therefore mandatory for different medical specialties.Careful assessment helps to identify the underlying pathophysiology of LUTS. Simple patient history or a symptom questionnaire cannot distinguish between LUTS of benign or malignant origin because the type of symptom or symptom severity is nonspecific for the underlying disease. This may limit the widespread assessment and treatment of LUTS by non-urologic professionals because special assessment tools-before treatment initiation-are usually not available in the offices of primary-care physicians (e.g., uroflowmeter, transrectal ultrasound, multichannel urodynamics, urethrocystoscopy). It is therefore crucial to know when nonurologists should transfer their patients to specialized urology care. An expert panel recommended specialized urology support in particular when physicians are in doubt of the origin or benign character of LUTS, in cases of macroscopic hematuria, or in men with absolute indications for prostate surgery [9].Adherence to guidelines is crucial for every medical specialty dealing with LUTS/BPH because real-life practice in the USA has shown that doctors who follow guidelines perform significantly less prostate surgery than doctors who do not [10]. Doctors with poor adherence to guidelines will have performed prostate surgery within the first year of diagnosis in 11 % of patients, whereas doctors with good adherence to guide...

Transurethral water vapor ablation of the prostate with the Rezūm system: Urodynamic findings

“…Several conditions are related to LUTS, including bladder dysfunction in terms of detrusor overactivity or underactivity and anatomical abnormalities of the lower urinary tract. 19 Therefore, the efficacy of an ablative therapy for the treatment of LUTS due to BPH should be evaluated not only in terms of the improvement of subjective symptoms but also for its objective impact on bladder outflow.…”

“…However, the assumption that LUTS and prostate enlargement (BPE) are two sides of the same coin is not properly correct. Several conditions are related to LUTS, including bladder dysfunction in terms of detrusor overactivity or underactivity and anatomical abnormalities of the lower urinary tract 19 …”