[Interest of a systematic assessment of the treatment of the lower urinary tract symptoms in the management of benign prostatic hypertrophy in general practice (1380 patients) - Study EVALURO]

Prog Urol. 2019 Feb;29(2):116-126. doi: 10.1016/j.purol.2018.12.003. Epub 2019 Jan 18.
[Article in French]

Abstract

Objective: To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms.

Methods: This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit.

Results: Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly.

Conclusion: A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.

Keywords: Alpha-bloquants; Benign prostatic hyperplasia; Hypertrophie bénigne de la prostate; Lower urinary tract symptoms; Prostate scores; Quality of life; Qualité de vie; Scores prostatiques; Symptômes du bas appareil urinaire; α-Blocker.

Publication types

  • Observational Study

MeSH terms

  • Adrenergic alpha-Antagonists / administration & dosage*
  • Aged
  • Aged, 80 and over
  • Follow-Up Studies
  • France
  • General Practice
  • General Practitioners
  • Humans
  • Lower Urinary Tract Symptoms / drug therapy*
  • Lower Urinary Tract Symptoms / etiology
  • Male
  • Middle Aged
  • Plant Extracts / administration & dosage
  • Prospective Studies
  • Prostatic Hyperplasia / drug therapy*
  • Prostatic Hyperplasia / physiopathology
  • Quality of Life*
  • Treatment Outcome

Substances

  • Adrenergic alpha-Antagonists
  • Plant Extracts