Lower urinary tract symptoms suggestive of benign prostatic obstruction: what are the current practice patterns?

The current clinical practice patterns for the management of LUTS suggestive of BPO in the US and in various European countries will be reviewed.

Information was obtained from published scientific articles and IMS/GERS market analysis data.

Community-based surveys demonstrate that the prevalence of moderate to severe LUTS in elderly men is high and increases with age. The role of the GP in the initial management of LUTS is growing. In France, Italy and the UK, most patients with LUTS initially visit a GP. More and more patients in the US also first seek medical advice from a primary care physician or an internal medicine specialist. In Germany, both GPs and office-based urologists are involved in the initial management of LUTS. In Poland and Spain, office-based urologists initiate primary therapy for LUTS, although a trend towards involvement of GPs is also seen, especially in Poland. The shift in the initial management of LUTS from secondary to primary care accompanies a decreased incidence of surgery and a growing demand for medical therapy. Currently, there are considerable differences between the medical management of LUTS suggestive of BPO across Europe in real life practice. For example phytotherapy is particularly popular in countries such as Germany, France and Spain, whereas finasteride is more commonly used in Italy, Poland and the UK. alpha(1)-Adrenoceptor antagonists are used in most of these countries as the primary treatment modality. The data furthermore suggest that the current management of patients is often more opinion- than evidence-based, which may at least partly be due to the fact that data on long-term effectiveness of treatment options in real life clinical practice are largely lacking.

[corrected] Due to the ageing and longevity of the population, the costs associated with the management of LUTS suggestive of BPO will rise in the future, whereas healthcare budgets will be relatively restricted. In order to improve cost-effective management of LUTS, more and better studies are needed in real life practice in primary care. These studies should not only be based on classical efficacy and safety data, but also on effectiveness of treatment in the long-term and the associated costs.