Clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and the efficacy of treating lower urinary tract symptoms

Abstract

Introduction. Benign prostatic hyperplasia (BPH) is a common condition in aging men that is often associated with lower urinary tract symptoms (LUTS).Objective. To determine the clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and develop an algorithm for improving the efficacy of treating lower urinary tract symptoms in benign prostatic hyperplasia.Materials & methods. The study included 112 BPH-patients who received tamsulosin therapy or a combination of tamsulosin + solifenacin for three months. After three months of therapy, the patients were divided into two groups depending on the effectiveness of therapy: group 1 — a positive result (n = 77); group 2 — no positive effect (n = 35). Due to the lack of efficacy in patients of group 2, a multichannel urodynamics was performed, according to the results of which the patients were prescribed treatment with a subsequent assessment of the result after 3 months.Results. After 3 months of therapy in patients of group 1, a decrease in pollakiuria was noted. Regression of obstructive and irritative symptoms was also observed, and the urination-associated quality of life (QoL) improved. The maximum urine flow rate (Q max) remained unchanged mainly. By the sixth month, the frequency of urination continued to decrease (11.05 vs 9.32 episodes; p = 0.022), as well as the improvement of other parameters (IPSS, QoL, Q max and post-void residual urine volume (PVR) (80.87 vs 56.17 ml; p = 0.012). The indicators of patients of group 2 following three months of therapy remained without significant changes. Sixteen patients underwent transurethral prostate resection, 19 patients underwent therapy correction, which allowed reducing the number of episodes of daily pollakiuria. The total IPSS score decreased by 4.37 compared to baseline (IPSS (obstructive) — 13.79 vs 7.26 pts; p = 0.032). The QoL value was 2.84 pts, Q max — 14.90 mL/s, PVR — 10.58 mL.Conclusion. 19.8% of BPH-patients are resistant to drug therapy. The ineffectiveness of therapy may be due to the severe BOO. In the absence of the effect of the therapy within 3 months, it is recommended to perform multichannel urodynamics. Correction of therapy according to the multichannel urodynamics data improves its effectiveness by the sixth month of treatment. Indicators of IPSS, Q max and PVR after 3 months of therapy allow predicting the effectiveness of therapy, or suspect the need for surgical treatment.