Widely-used treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) provide similar symptom relief and improvement in quality of life, according to a real-world study of clinical practice in Spain.

Previous studies have focused largely on individual therapies, so investigators led by Jose Manasanch, PhD, of Pierre Fabre Iberica S.A. in Spain, compared treatments based on representative patients from contemporary practice. The prospective Quality of Life in Benign Prostatic Hyperplasia study involved 119 urologists and 1,713 patients with moderate to severe LUTS/BPH (older than 40 years) from outpatient clinics across Spain. The study excluded men with complicating factors, such as other urological disorders, surgery, or recent treatment with medication affecting the urinary system.

Most patients (70%) were prescribed monotherapy with alpha-adrenergic blockers (AB), 5-alpha reductase inhibitors (5-ARIs), or phytotherapy (mostly hexanic extract of Serenoa repens). Nearly 21% received combined treatment. Patients took medication at recommended doses and adherence was high. About 9% of patients chose watchful waiting.

After 6 months, improvements in quality of life were similar across treatment groups for both monotherapy and combined therapy based on the Benign Prostatic Hyperplasia Impact Index and the International Prostate Symptom Score. The magnitude of improvement was similar to that reported in previous studies using these measures. Patients with more severe symptoms experienced greater improvement. All treatments outperformed watchful waiting.

Hexanic extract of S. repens appeared similarly effective to AB and 5-ARI treatment, either as monotherapy or in combination with AB, without affecting sexual function. A European Medicines Agency report concluded that only the hexanic extract has evidence to support its use, according to the investigators. They also acknowledged that patients receiving phytotherapy tended to be younger and have less severe symptoms. 

About 10% of patients receiving AB and/or 5-ARIs reported problems with sexual functioning, similar to previous research. Ejaculatory dysfunction was commonly reported.
“The results of this study add to the evidence pool on current treatments for LUTS/BPH and should help to further inform decision-making regarding treatment,” Dr. Manasanch and colleagues concluded in International Urology and Nephrology. “Such decision-making should also take into account the patient's clinical condition and their risk-benefit preferences. 

​As this was an observational study, the possibility of selection bias cannot be eliminated. Future studies also might address LUTS/BPH progression, the researchers suggested.

Bladder wall thickness (BWT) may offer a quick and easy way to predict severity of bladder outlet obstruction (BOO) in men, researchers say.

In a study of 236 men with lower urinary tract symptoms secondary to benign prostatic hyperplasia, Özer Güzel, MD, and colleagues at the Ankara Numune Research and Training Hospital in Turkey, examined the relationship between BWT and poor indictors for BOO: International Prostate Symptom Score (IPSS) above 19, Qmax less than 15 mL/min, and post-void residual (PVR) greater than 100 mL. The investigators used suprapubic ultrasonography to measure BWT.
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Patients had a mean age of 62.5 years and mean BWT of 3.8 mm. The mean IPSS, Qmax, PVR, and duration of LUTS were 17.7, 13.7 mL/min, 89.9 mL, and 46.5 months, respectively, the investigators reported in Urology (2015;86:439-444). Results showed that BWT increased when the number of BOO parameters increased. BWT was 2.9 mm in patients without BOO, whereas BWT was 3.5, 4.1, and 4.5 mm in patients with any 1, any 2, and all parameters of BOO, respectively.