How to Help Men with LUTS Help Themselves
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Lower Urinary Tract Symptoms (LUTS) in men is extremely common and usually is associated with an enlarged prostate. LUTS/BPH (benign prostatic hyperplasia) is estimated to cause more than 8 million physician office visits per year in the United States and uses considerable health care resources. Because the U.S. male population is aging, the economic burden of male LUTS is expected to increase significantly. Current treatment guidelines suggest a step-up approach. Most patients start with pharmacological treatments and suggested changes in specific behaviors, followed by some form of minimally invasive therapy if drugs and behavioral changes are not successful. It is not unusual for some patients to end with a surgical intervention. Though medical therapies such as alpha blockers, 5-alpha reductase inhibitors, PDE5 inhibitors, and anticholinergics may provide some temporary relief, adherence is a major issue either due to lack of long-term efficacy or unwanted side effects. Only one out of four patients remains on drugs after a year. In addition, patient expectations from offered treatments can be different from what the treatment achieves. Long-term patient satisfaction with minimally invasive treatments or surgical therapies also may not be optimal. There is a need to enhance the ability to engage in and maintain behavioral interventions for secondary prevention strategies in men with LUTS.
Although there are many examples in other fields of medicine, there is a paucity of literature on methods for behavioral interventions for LUTS in men and even less literature employing specific self-management skills such as goal setting, self-monitoring, and problem solving. Most of the published data on non-urologic factors that may contribute to LUTS are based on low-quality evidence. Many patients learn to cope with their symptoms themselves by adopting adaptive behaviors such as restricting fluids before sleep, precautionary voiding, and avoiding caffeinated or alcoholic beverages and certain drugs. There are a number of modifiable lifestyle factors that may impact LUTS. If taught properly, most men could learn how to manage their LUTS. A substantial proportion of men with LUTS can be educated to postpone initiation of medical or surgical therapies and associated side effects/complications.
- To review the evidence on various factors impacting LUTS in men
- To discuss the knowledge base for self-management of LUTS in men
- To identify potential intervention strategies to reduce the impact of LUTS on the quality of life of men
September 20, 2016