Most men won’t discuss them unless you ask

Urinary tract problems: most men won’t discuss them unless you ask

Betsy Bates

ANAHEIM, CALIF. — Only about a third of men with moderate to severe lower urinary tract symptoms and evidence of an enlarged prostate intended to discuss these issues during a routine visit to their primary care physicians, according to a national, multisite study presented at the annual meeting of the American Urological Association.

Dr. Michael J. Naslund and his associates from the University of Maryland, Baltimore, distributed a questionnaire to 448 men older than age 50 years when they arrived for routine appointments at one of six primary care practices across the United States. The men were roughly evenly distributed by age, with 153 in their 50s, 151 in their 60s, and 144 in their 70s.

The men were asked the reason for their visit, their current lower urinary tract symptoms (LUTS), prior history of use of drugs and herbal remedies to treat LUTS, and whether they were planning to discuss their symptoms with the physician. A total of 42% of the men described moderate to severe LUTS on the International Prostate Symptom Score (IPSS) scale.

Upon enrollment, 48% of the men had an enlarged prostate on digital rectal examination (DRE) and 43% had a prostate-specific antigen level of 1.5 ng/ml. or greater. Two-thirds of the men had either an enlarged prostate on DRE or an elevated PSA level.

An estimated 29% of the men in the study would be considered at risk for progression of symptoms of benign prostatic hypertrophy, based on a high score on the IPSS scale and either a positive DRE or elevated PSA level.

Just 33% of men in this at-risk group–who were fairly evenly distributed by age–said they intended to discuss LUTS or prostate issues with their primary care physicians.

This finding “raises the possibility that primary care physicians may need to increase their efforts to detect men with LUTS and enlarged prostates,” said Dr. Naslund, professor of surgery and interim head of urology at the university.

Of all the men in the study, 19% had used [alpha]-blockers at some time, 4% had used 5[alpha]-reductase inhibitors, and 9% had used herbal remedies.

Nearly 50% of those with a score greater than 7 on the IPSS (0-7 mildly symptomatic, 8-19 moderately symptomatic, 20-35 severely symptomatic) had used one of these therapeutic agents.

Dr. Naslund disclosed that he is a consultant and on the speaker’s bureau for GlaxoSmithKline Inc. and Sanofi Aventis, makers of pharmaceuticals for benign prostate hypertrophy.


Los Angeles Bureau

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