LUTS likely to resolve without treatment

Dec 9 2013

By Joanna Lyford, Senior medwireNews Reporter

Lower urinary tract symptoms (LUTS) in men tend to follow a fluctuating course with marked variability in symptoms over time, a 5-year study has shown.

The study also found that approximately 50% of LUTS resolve without treatment, a figure with important implications for clinical decision-making.

Antti Pöyhönen (Central Finland Central Hospital, Jyväskylä, Finland) and team used a questionnaire to evaluate 1331 men with LUTS who were aged 55 years, 65 years, or 75 years at baseline, and the same questionnaire to re-evaluate them 5 years later.

LUTS were evaluated using the Danish Prostatic Symptom Score. At baseline, each symptom was dichotomized as either absent or clinically significant; then, at follow-up, changes were classified into four groups: remained asymptomatic, new (incident) symptom, remission of previous symptom, and persistent symptom.

Writing in Urology, Pöyhönen and colleagues report that all 12 symptoms fluctuated considerably over time, and that remission was more common than occurrence for all symptoms.

The proportion of symptoms that resolved during follow-up ranged from 22% to 89%, depending on the individual LUTS, while the proportion of new symptoms ranged from 1% to 13%.

Incontinence, dysuria, and weak stream had the lowest incidence, while post-micturition symptoms and urgency had the highest incidence.

Among men with voiding symptoms at baseline, such as hesitancy and straining, roughly half resolved during follow-up. Remission was less likely for storage symptoms such as urgency and other incontinence, with remission rates of just 20% to 30%.

“Incidence of specific symptoms varied by a factor of 10 and remission by a factor of 4,” the authors summarize. “Overall, common symptoms varied most strongly in terms of incidence and remission, whereas the less common ones such as incontinence behaved in a more stable fashion.”

Noting that men receiving treatment for LUTS were excluded from the study, the authors remark that “this spontaneous fluctuation of LUTS can be incorrectly interpreted as treatment effect in clinical practice or in treatment studies,” a possibility that “has implications for clinical decision-making.”

They warn: “The high frequency of spontaneous recovery should be considered when prescribing medication for LUTS or evaluating treatment effects.”

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