Severity of lower urinary tract symptoms reflects different composition of bladder storage dysfunction and bladder outlet obstruction in men with symptomatic benign prostatic hyperplasia.
OBJECTIVE
Differentiation of different lower urinary tract dysfunctions (LUTD) is essential for selecting the optimal first-line medical treatment of lower urinary tract symptoms (LUTS). This study analysed the association of the severity of LUTS with LUTD and therapeutic results based on the International Prostate Symptom Score (IPSS) voiding to storage (V/S) ratio.


METHODS
Lower urinary tract symptoms were evaluated in 849 men using the IPSS questionnaire and the IPSS-V/S ratio. The prostate measures, urinary flow measures, and C-reactive protein (CRP) were investigated at baseline and 1 month after treatment. Therapeutic results were assessed by changes in the quality of life index (QoL-I). The associations of the severity of LUTS with LUTD and therapeutic results were analysed.


RESULTS
Mild (IPSS ≤ 7), moderate (8 ≤ IPSS ≤ 19) and severe LUTS (IPSS ≥ 20) were noted in 215, 461 and 173 men. IPSS-V/S ≤ 1 was noted in 81.4% of patients with mild LUTS, while IPSS-V/S > 1 was noted in 71.1% of patients with severe LUTS. After treatment with alpha-blockers in patients with IPSS-V/S > 1 and antimuscarinic agents in patients with IPSS-V/S ≤ 1 for 1 month, 84.0% and 88.8% of patients with mild LUTS had effective therapeutic results, respectively. In contrast, the therapeutic results were less effective in patients with moderate (64.9% and 63.8%, respectively) or severe LUTS (50% and 33.3%, respectively).


CONCLUSIONS
Patients with benign prostatic hyperplasia (BPH) and mild LUTS have more bladder storage dysfunction, whereas patients with BPH and severe LUTS had higher grade of bladder outlet disorders in associated with storage symptoms. Treatment based on the IPSS-V/S ratio results in good therapeutic results in men with mild and moderate LUTS, but not in men with severe LUTS.
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
J-F
JF
Jhang
C-H
CH
Liao
H-C
HC
Kuo
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D001748:Urinary Bladder Neck Obstruction / Q000145:classification*; D014554:Urination / Q000502:physiology*
D018727:Muscarinic Antagonists