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Baseline symptom score and flow rate can predict failure of medical treatment of lower urinary tract symptoms: prospective 12-year follow-up study

Baseline symptom score and flow rate can predict failure of medical treatment of lower urinary tract symptoms: prospective 12-year follow-up study
Baseline symptom score and flow rate can predict failure of medical treatment of lower urinary tract symptoms: prospective 12-year follow-up study

Objective: to assess predictors of failure of medical treatment of lower urinary tract symptoms (LUTS) and evaluate long-term outcome.

Methods: between January 1993 and September 1994, 178 men referred with LUTS were prospectively recruited. Assessments included maximum urine flow (Qmax), postvoiding residuals (PVR), transrectal ultrasound (TRUS) prostate volumes, American Urological Association symptom score, and validated quality of life (QOL) and bother scores. Treatment failure was defined as need for transurethral resection of the prostate (TURP). Data were collected at baseline, with final follow-up at 12 years. Univariate and multivariate analyses used Kaplan-Meier and the Cox proportional hazards regression model, respectively, to assess covariates on risk of failure and independent variable prognostic values.

Results: median follow-up was 7.9 years (range, 0-12 years). The mean QOL baseline score of 7.1 improved to 3.6 at 6 years and to 3.3 at 12 years (P <.05 for all). Fifty patients (28%) underwent TURP, with 36 undergoing TURP within 3 years. By univariate analysis, Qmax, AUA and bother scores, and PVR were significantly associated with treatment failure. Independent predictors of failure by multivariate Cox regression were Qmax (>15 vs <15 mL/s; hazard ratio, 3.37; 95% confidence interval, 1.74-6.52; P <.0001) and bother score (<13 vs >13; hazard ratio, 2.37; 95% confidence interval, 1.29-4.35; P = .005). At 12 years, AUA, QOL, and bother scores statistically improved compared with baseline (13 vs 8, 10 vs 6, and 5 vs 2, respectively). Limitations included attrition bias from nonresponders.

Conclusions: the beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores.

5-alpha Reductase Inhibitors, Adrenergic alpha-Antagonists, Aged, Aged, 80 and over, Cholinergic Antagonists, Drug Therapy, Combination, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Organ Size, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Prostate, Prostatectomy, Prostatism, Quality of Life, Severity of Illness Index, Treatment Failure, Ultrasonography, Urodynamics, Journal Article
0090-4295
390-394
Mishriki, Said Fadel
1cdff697-8825-49da-9432-c385f4a2c415
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Graham, John T
97055c96-15fe-4c1b-828d-8e3db934625f
Lam, Thomas B
2cf67be7-a52d-45f7-9a6c-6c7bb83e9ba8
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Mishriki, Said Fadel
1cdff697-8825-49da-9432-c385f4a2c415
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Graham, John T
97055c96-15fe-4c1b-828d-8e3db934625f
Lam, Thomas B
2cf67be7-a52d-45f7-9a6c-6c7bb83e9ba8
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Mishriki, Said Fadel, Aboumarzouk, Omar, Graham, John T, Lam, Thomas B and Somani, Bhaskar K (2013) Baseline symptom score and flow rate can predict failure of medical treatment of lower urinary tract symptoms: prospective 12-year follow-up study. Urology, 81 (2), 390-394. (doi:10.1016/j.urology.2012.08.104).

Record type: Article

Abstract

Objective: to assess predictors of failure of medical treatment of lower urinary tract symptoms (LUTS) and evaluate long-term outcome.

Methods: between January 1993 and September 1994, 178 men referred with LUTS were prospectively recruited. Assessments included maximum urine flow (Qmax), postvoiding residuals (PVR), transrectal ultrasound (TRUS) prostate volumes, American Urological Association symptom score, and validated quality of life (QOL) and bother scores. Treatment failure was defined as need for transurethral resection of the prostate (TURP). Data were collected at baseline, with final follow-up at 12 years. Univariate and multivariate analyses used Kaplan-Meier and the Cox proportional hazards regression model, respectively, to assess covariates on risk of failure and independent variable prognostic values.

Results: median follow-up was 7.9 years (range, 0-12 years). The mean QOL baseline score of 7.1 improved to 3.6 at 6 years and to 3.3 at 12 years (P <.05 for all). Fifty patients (28%) underwent TURP, with 36 undergoing TURP within 3 years. By univariate analysis, Qmax, AUA and bother scores, and PVR were significantly associated with treatment failure. Independent predictors of failure by multivariate Cox regression were Qmax (>15 vs <15 mL/s; hazard ratio, 3.37; 95% confidence interval, 1.74-6.52; P <.0001) and bother score (<13 vs >13; hazard ratio, 2.37; 95% confidence interval, 1.29-4.35; P = .005). At 12 years, AUA, QOL, and bother scores statistically improved compared with baseline (13 vs 8, 10 vs 6, and 5 vs 2, respectively). Limitations included attrition bias from nonresponders.

Conclusions: the beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores.

Full text not available from this repository.

More information

Accepted/In Press date: 31 August 2012
Published date: February 2013
Additional Information: Copyright © 2013 Elsevier Inc. All rights reserved.
Keywords: 5-alpha Reductase Inhibitors, Adrenergic alpha-Antagonists, Aged, Aged, 80 and over, Cholinergic Antagonists, Drug Therapy, Combination, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Organ Size, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Prostate, Prostatectomy, Prostatism, Quality of Life, Severity of Illness Index, Treatment Failure, Ultrasonography, Urodynamics, Journal Article

Identifiers

Local EPrints ID: 419107
URI: https://eprints.soton.ac.uk/id/eprint/419107
ISSN: 0090-4295
PURE UUID: 5e4d3aae-c644-4bfa-81cd-b05a0c6093cf

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Date deposited: 05 Apr 2018 16:30
Last modified: 13 Mar 2019 18:44

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