The focus of this study was on the four symptoms: urgency, nocturia, slow stream and post-micturition dribble. These symptoms were chosen because we intended to study every one of the three categories of LUTS 1) Voiding symptoms (including frequency, nocturia, urgency and urinary incontinence) – with urgency as the cardinal symptom, signifying underlying overactive bladder 2) Storage symptoms – (including hesitancy, intermittency, slow stream and straining and terminal dribble) with slow stream is a key voiding symptom that suggests voiding dysfunction, in particular, bladder outlet obstruction, and 3) Post micturition symptoms (including post micturition dribble and feeling of incomplete bladder emptying) - post micturition dribble is a common annoying symptom with religious implications in many men living in Southeast Asia. Nocturia is known to have many causes and to be one of the most prevalent and bothersome of LUTS. There is thinking of separating nocturia as a single disease entity distinct from LUTS and hence nocturia was singled out for further study in this survey.
Results from this survey showed that in the secondary care setting, LUTS often coexisted and were combined with nocturia in many men. There are marked differences among Asian countries in self-reported symptom prevalence and perception of bother. These differences may be reflective of the differences in the healthcare system across the countries, in particular, the waiting time and ease of access to urologist care. The results may reflect the difference in the level of pro-activeness and involvement of primary care physicians in treating LUTS. Not expectedly, nearly half of patients had received some form of prescribed treatment. One explanation in the variation of the degree of bother at the time of consulting with the urologist maybe the difference in the bother thresholds across the countries – more tolerant, hence lower bother scores.
This study provided information on the symptomatic profiles of men with LUTS attending urology clinics, and identified patient needs in terms of their perceived degree of symptom bother and treatment satisfaction. The study helped inform the need for any specialized units to provide education and treatment for individual symptom of LUTS, and helped guide the planning of healthcare policies and allocation of resources. LUTS in men used to be simplistically attributed just to the prostate.
Written by: Dr Lap-yin Ho, Convenor of Southeast Asia Urology Think Tank
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