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Randomized Controlled Trial
. 2006 Dec;56(533):938-44.

The effectiveness of a treatment protocol for male lower urinary tract symptoms in general practice: a practical randomised controlled trial

Roelf J C Norg  1 , Kees van de Beek, Piet J M Portegijs, C P Onno van Schayck, J André Knottnerus
Affiliations
Randomized Controlled Trial

The effectiveness of a treatment protocol for male lower urinary tract symptoms in general practice: a practical randomised controlled trial

Roelf J C Norg et al. Br J Gen Pract. 2006 Dec.

Abstract

Background: Randomised controlled trials have shown the efficacy of several treatment modalities for lower urinary tract symptoms (LUTS) in selected populations. The effectiveness in daily practice has hardly been investigated, especially in primary care and is dependent on choices between all possible treatment options and best investigated in a comprehensive study, including all treatment modalities (watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors, and surgery).

Aim: Assessment of the effectiveness of a comprehensive treatment protocol for LUTS in primary care.

Design of study: Randomised controlled trial.

Setting: Fourteen general practices in the Netherlands.

Intervention: treatment protocol based on a formalised expert opinion. Control condition: usual care.

Study population: 208 subjects with moderate to severe LUTS (IPSS > or =8, median = 13).

Outcome measures: symptom severity (IPSS [International Prostate Symptom Score]), bother score (Dan-PSS [Danish Prostate Symptom Score]), and maximum urinary flow (Q(max)); incidence of acute urinary retention and urinary tract infections.

Results: In the intervention group markedly more subjects used an alpha-blocker at end of follow-up than in the usual care group (24% versus 6%). No significant differences were found between intervention and control group in IPSS, Q(max) or Dan-PSS.

Conclusion: alpha-blockers and watchful waiting are the most frequent treatment modalities for LUTS in primary care. Our study showed no evidence that a protocol using well-defined indications for all possible treatment modalities based on a formalised expert opinion procedure has added value. Based on our results, we cannot recommend a broadening of the indication for alpha-blockers, which, however, seems to be the current trend.

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Figures

Figure 1
Figure 1
Recruitment of study population.
Figure 2
Figure 2
Flow of participants through the study.
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