LUTS, the Case Is Altered

Abstract

Objective: To explore the current understanding, beliefs and perceptions of European urologists regarding the aetiology, diagnosis and management of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and match them with current scientific literature and guidelines. Methods: European urologists with a European Association of Urology (EAU) membership and an e-mail address were invited to register with the urologist panel. Every newly registered urologist was validated and invited to complete a web-based survey. The results of the survey are presented by means of descriptive statistics. Results: In total, 119 European urologists from 27 countries were included in our analyses, of which 115 completed all questions. Most respondents agreed that besides obstruction, bladder instability, ageing, co-morbidity and central nervous system disorders are also involved in the aetiology of LUTS. They believed that voiding symptoms are predominantly related to obstruction, and storage symptoms to bladder instability. Whether the latter is only due to bladder changes secondary to obstruction or also due to (upregulated) α 1D-adrenoceptor subtypes in the bladder remains controversial and should be further investigated, although the majority of the respondents believed that α 1-adrenoceptor antagonists blocking both α 1A- and α 1D-adrenoceptor subtypes directly target the prostate and the bladder. The respondents acknowledged the importance of bladder protection in the long-term management of LUTS/BPH for reducing the risk of serious complications. They did not consider an increased bladder mass a relevant risk factor for serious complications and did not recommend ultrasound estimated bladder weight (UEBW) as a diagnostic test. Furthermore, prostate size was not perceived as a risk factor, in marked contrast to the published literature. Main elements in the current risk evaluation are post-void residual urine volume, urinary flow and symptom severity. Both transurethral resection of the prostate (TURP) and α 1-adrenoceptor antagonists were considered effective for the relief of voiding and storage symptoms with TURP having a greater effect on voiding symptoms, whereas the effect on storage symptoms of both treatments was appreciated as similar. TURP was perceived as the most effective treatment for reducing obstruction and the risk of acute urinary retention (AUR). “Selective α 1-adrenoceptor antagonists (e.g. tamsulosin)” and phytotherapy were considered the best tolerated treatments. Finally, the respondents believed that patients at risk for serious complications may benefit from long-term treatment with α 1-adrenoceptor antagonists. Conclusions: The results of this survey show that the respondents were familiar with new concepts in the aetiology and management of LUTS/BPH, so it seemed that a paradigm shift is present among European urologists. The results give us an idea about the future directions in the management of LUTS/BPH. The most striking finding of this survey seems to be the lack of clarity over the significance of an increased bladder mass in the long-term management of LUTS/BPH. More research, especially regarding long-term complications, is needed to provide better insight into this and to find out who should be treated, for how long, with which type of treatment and when treatment should be started to prevent/reduce serious complications.