title: The effectiveness of a treatment protocol for male lower urinary tract symptoms in general practice: a practical randomised controlled trial.
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).
  
  
  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.
authors.affiliation: Department of General Practice, Care and Public Health Research Institute, Maastricht University, Netherlands. roelf.noerg@hag.unimaas.nl
authors.forename: Roelf J C
authors.initials: RJ
authors.lastname: Norg
authors.forename: Kees
authors.initials: K
authors.lastname: van de Beek
authors.forename: Piet J M
authors.initials: PJ
authors.lastname: Portegijs
authors.forename: C P Onno
authors.initials: CP
authors.lastname: van Schayck
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: 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
chemical_list: D004791:Enzyme Inhibitors; D013449:Sulfonamides; D018120:Finasteride; D000077409:Tamsulosin