Lower urinary tract symptoms: what are the implications for the patients?

Patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) complain about symptoms such as weak stream, dribbling, intermittency, frequency, nocturia and urgency. To effectively manage these symptoms, it is important to better understand the epidemiology and/or the bothersomeness of these symptoms, the impact of the symptoms on the patient's quality of life and life style, when and why patients seek medical advice and the subsequent management of LUTS/BPH in clinical practice. This paper gives an overview of these issues considering 3 recently conducted European surveys. Although voiding symptoms are more frequent in patients with LUTS/BPH, storage symptoms, such as frequency, urgency, nocturia and urge incontinence, seem to be more bothersome to the patients. LUTS seem to have a negative impact on the patient's quality of life and sexuality and to interfere strongly with daily life activities. With regard to sexuality, interference with the patient's overall sex life and erection problems is experienced as much more bothersome than ejaculation problems. After the initial symptoms, most patients postpone a visit to the physician and try to adjust their life style to self manage their symptoms. Eventually they seek medical advice because they are too much bothered by their LUTS. In Italy, medical therapy is the most frequently administered treatment option by urologists (57% of patients) followed by surgery (37% of patients). alpha(1)-Adrenoceptor antagonists are the predominant medical therapy prescribed (70% of all medically treated patients), particularly tamsulosin (35% of all medically treated patients). An interview with European urologists confirms that alpha(1)-adrenoceptor antagonists, especially newer uro-selective ones like tamsulosin, are a very appropriate initial treatment choice in the management of both voiding and storage LUTS.