Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM)

Amanda L. Lewis, Grace J. Young, Paul Abrams, Peter S. Blair, Christopher Chapple, Cathryn M.A. Glazener, Jeremy Horwood, John S. McGrath, Sian Noble, Gordon T. Taylor, Hiroki Ito, Mohammed Belal, Melissa C. Davies, Andrew J. Dickinson, Charlotte L. Foley, Steve Foley, Simon Fulford, Mohsen M. Gammal, Mary Garthwaite, Mark R.E. HarrisPetre C. Ilie, Robert Jones, Samer Sabbagh, Robert G. Mason, Ester McLarty, Vibhash Mishra, Jaswant Mom, Roland Morley, Salvatore Natale, Tharani Nitkunan, Tobias Page, David Payne, Tina G. Rashid, Kasra Saeb-Parsy, Sarb S. Sandhu, Adrian Simoes, Gurpreet Singh, Mark Sullivan, Heidi V. Tempest, Srinivasa Viswanath, Roger M.H. Walker, J. Athene Lane, Marcus J. Drake*

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). Objective: To report participants’ sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. Design, setting, and participants: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. Intervention: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). Outcome measurements and statistical analysis: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. Results and limitations: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. Conclusions: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. Patient summary: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics. Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage lower urinary tract symptoms and impaired sexual function. Sociodemographic and clinical evaluations were similar between arms. The overall mean International Prostate Symptom Score and quality of life score were 18.94 and 4.13, respectively. Men undergoing urodynamic evaluation expressed high satisfaction with the procedure.

Original languageEnglish
Pages (from-to)340-350
Number of pages11
JournalEuropean Urology Focus
Volume5
Issue number3
Early online date30 Apr 2019
DOIs
Publication statusPublished - May 2019

Keywords

  • Benign prostatic obstruction
  • Bladder outlet obstruction
  • Detrusor overactivity
  • Detrusor underactivity
  • Lower urinary tract symptoms
  • Patient-reported outcome measures
  • Prostate
  • Surgery
  • Underactive bladder
  • Urodynamics
  • STORAGE
  • LASER
  • PREVALENCE
  • HYPERPLASIA
  • PHOTOSELECTIVE VAPORIZATION
  • QUALITY-OF-LIFE
  • TRANSURETHRAL RESECTION

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    Lewis, A. L., Young, G. J., Abrams, P., Blair, P. S., Chapple, C., Glazener, C. M. A., Horwood, J., McGrath, J. S., Noble, S., Taylor, G. T., Ito, H., Belal, M., Davies, M. C., Dickinson, A. J., Foley, C. L., Foley, S., Fulford, S., Gammal, M. M., Garthwaite, M., ... Drake, M. J. (2019). Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) . European Urology Focus, 5(3), 340-350. https://doi.org/10.1016/j.euf.2019.04.006