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


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


METHODS
Randomised controlled trial.


METHODS
Fourteen general practices in the Netherlands.


METHODS



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


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


METHODS
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.


CONCLUSIONS
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.
Norg
Roelf J C
RJ
Department of General Practice, Care and Public Health Research Institute, Maastricht University, Netherlands. roelf.noerg@hag.unimaas.nl
van de Beek
Kees
K
Portegijs
Piet J M
PJ
van Schayck
C P Onno
CP
Knottnerus
J André
JA
D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005194:Family Practice; D018120:Finasteride / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D016896:Treatment Outcome; D016055:Urinary Retention / Q000188:drug therapy* / Q000209:etiology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000209:etiology
D004791:Enzyme Inhibitors; D013449:Sulfonamides; D018120:Finasteride; D000077409:Tamsulosin