Analyzing and Characterizing Why Men Seek Care for Lower Urinary Tract Symptoms
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BENIGN PROSTATIC HYPERPLASIA (K MCVARY, SECTION EDITOR)
Analyzing and Characterizing Why Men Seek Care for Lower Urinary Tract Symptoms Alex Landau 1 & Charles Welliver 1,2 Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The goal of this paper is to summarize existing literature on prevalence of lower urinary tract symptoms (LUTS) that may be attributed to benign prostatic hyperplasia (BPH, LUTS/BPH), factors associated with seeking treatment and treatment success, and subjective and objective methods of evaluating LUTS. Recent Findings Men primarily seek treatment for LUTS/BPH because bother overcomes barriers to treatment. Factors such as severity, bother, or persistence of symptoms primarily motivate individuals to seek treatment, while low-symptom severity mainly leads individuals to not seek treatment. Among men that seek treatment, nocturia and storage symptoms predominate. LUTS are assessed with self-report questionnaires; subjective evaluations translate moderately well to objective measurements of LUTS severity. Summary Current symptom classifications and patient groupings may be overly simplified and not evidence-based. Further studies evaluating novel symptom clusters and patient-centered BPH treatment approaches can guide future treatment. Keywords Lower urinary tract symptoms . Benign prostatic hyperplasia . Care-seeking behavior
Introduction Lower urinary tract symptom (LUTS) is an umbrella term with many causes including neurologic, prostate changes, bladder dysfunction, and other age-related changes. While benign prostatic hyperplasia (BPH) is commonly used interchangeably with LUTS in older men, this term is narrowly defined as a histologic diagnosis characterized by progressive, non-malignant growth of prostatic cells. While most of the pathology in at least in older men is LUTS attributed to BPH (LUTS/BPH), our understanding of the interaction between the prostate and the nuances of voiding dysfunction have expanded recently. Classically, authors have described LUTS using traditional characterization of storage, voiding, and possibly postThis article is part of the Topical Collection on Benign Prostatic Hyperplasia * Charles Welliver [email protected] 1
Division of Urology, Albany Medical College, 23 Hackett Blvd, Albany, NY 12208, USA
2
Albany Stratton Veterans Affairs Medical Center, Albany, NY, USA
micturition categories. Storage symptoms (previously described as “irritative”) include nocturia, frequency, and urgency. Voiding symptoms include hesitancy, intermittency, double voiding, and incomplete emptying and were previously called “obstructive” symptoms. While not always acknowledged, post-micturition symptoms (e.g., post-void dribbling) may be included. While these are certainly still applicable, these categories are broad and do not exclusively group symptoms by pathologic etiology. For instance, frequency may be due to bladder overactivity (classically a cause of storage symptoms) or due to a need for frequenc
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