Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic and care pathway

• Published in: International journal of clinical practice (Esher) Vol. 70; no. 9; pp. 734 - 743
• Main Authors: Carbone, Antonio, Fuschi, Andrea, Al Rawashdah, Samer Fathi, Al Salhi, Yazan, Velotti, Gennaro, Ripoli, Andrea, Autieri, Domenico, Palleschi, Giovanni, Pastore, Antonio Luigi
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.09.2016
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Aftercare; Aged; Combined Modality Therapy; Critical Pathways; Diagnostic Techniques, Urological; Erectile Dysfunction - diagnosis; Erectile Dysfunction - etiology; Humans; Lower Urinary Tract Symptoms - diagnosis; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - therapy; Male; Physical Therapy Modalities; Prostatic Hyperplasia - complications; Risk Reduction Behavior; Surveys and Questionnaires; Treatment Outcome; Urinary Bladder Neck Obstruction - diagnosis; Urinary Bladder Neck Obstruction - etiology; Urinary Bladder Neck Obstruction - therapy; Urodynamics - physiology
• ISSN: 1368-5031; 1742-1241; 1742-1241
• DOI: 10.1111/ijcp.12849

Summary Introduction Benign prostatic hyperplasia (BPH) resulting in lower urinary tract symptoms (LUTS) is a widespread disease that strongly interferes with the quality of life (QoL) of elderly males. It represents a real clinical and socio‐economic problem may be due to the lack of a diagnostic, therapeutic and care pathway (DTCP) tool for LUTS/BPH that considers elderly people population in its whole complexity. The aim of this study was to evaluate the clinical effectiveness of the proposed DTCP LUTS/BPH tool. Methods This prospective study was conducted on 278 patients over 75 years old with non‐neurogenic LUTS recruited from February to July 2014 by 10 general practitioners (GP) and two assisted sanitary residences (ASR). Only five GPs and one ASR were provided with the complete DTCP LUTS/BPH tool to create two different groups of patients: group A (138 patients) was treated without the aid of the DTCP; group B (140 patients) was treated according to the DTCP. Results At 1 year of follow‐up, the patients of Group B compared with Group A achieved a greater and significant mean reduction in the questionnaires score (International Prostate Symptom Score, Quick prostate test and QoL) linked to a higher increase in the flowmetry parameters (Qmax) and a lower postvoid residual. Furthermore, in Group B compared to Group A, a greater improvement of hydronephrosis, creatinine values and erectile dysfunction (ED) were obtained at 1 year of follow‐up. Conclusion The encouraging results obtained from this study are significant and support the use of this diagnostic, therapeutic and care tool (DTCP) as the ideal pathway management for elderly men with LUTS associated to BPH and ED. Further studies with greater number of elderly subjects and long‐term follow‐up are needed to confirm DTCP utility in the clinical management of LUTS/BPH and ED.