Is the current practice providing an integrated approach to the management of LUTS and ED in primary care? An audit and literature review.
BACKGROUND
Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are highly prevalent in aging men. A common pathophysiology is hypothesized to explain causal link. However, prevalence of ED in patients with LUTS remains underdiagnosed, as we believe general practitioners (GPs) do not inquire about ED in men presenting with LUTS.


OBJECTIVE
Our goal to find out if LUTS and ED were dealt with in an integrated fashion in primary care.


METHODS
One hundred consecutive patients with LUTS attending the prostate assessment clinic anonymously completed a locally developed, qualitatively validated questionnaire and sexual health inventory for men.


METHODS
(i) Prevalence of concomitant ED in men presenting with LUTS; (ii) proportion of GPs enquiring about ED; (iii) patients with LUTS + ED who were offered treatment in primary care; and (iv) patients who sought treatment on review in secondary care.


RESULTS
The age of patients was 39-86 years. Fifty-four percent admitted to ED: 66% >/=60 years, and 28% </=60 years had ED. Mean international prostate symptom score in both LUTS +/- ED groups was 16. There was a direct correlation between severity of LUTS and ED. Only 13/54 (24%) admitted ED to their GP. Of the patients, 15.4% received treatment, but 90.9% untreated patients were interested in therapy. Seventy-one percent stated definite reasons for inability to discuss their ED. GPs inquired about ED in only 9.2%. Overall, 66.6% wanted their ED addressed.


CONCLUSIONS
Fifty-four percent of the patients with LUTS also admitted to ED. Patients with more severe LUTS had more severe ED. More than 75% of patients did not report coexistent ED. GPs inquired about ED in only <10% of patients and offered no therapy to more than 80%. Sixty-seven percent of LUTS patients were interested in receiving treatment for ED when offered. A more integrated approach is desired to address the prevalence of ED in patients presenting with LUTS in order to offer them a comprehensive management in primary care.
Chitale
Sudhanshu
S
Norfolk and Norwich University Hospital NHS Trust--Urology, Norwich, UK. chitalenorwich@aol.com
Collins
Robert
R
Hull
Sue
S
Smith
Elizabeth
E
Irving
Stuart
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D012720:Severity of Illness Index; D012725:Sexual Behavior / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D014555:Urination Disorders / Q000453:epidemiology* / Q000628:therapy