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Could self-management challenge pharmacotherapy as a long-term treatment for uncomplicated lower urinary tract symptoms?

Brown, Christian Ta; Emberton, Markb

Benign prostatic hyperplasia

Purpose of review This review highlights the lifestyle and behavioural management strategies (self-management) available to men with lower urinary tract symptoms.

Recent findings Pharmacotherapy has evolved considerably over the last decade and now most men with lower urinary tract symptoms are treated at some point with either single or combined therapy. However, recent studies reporting the longer term usage of pharmacotherapy have shown significantly high rates of discontinuation due to patient compliance, treatment ineffectiveness, side effects and patient choice. Not all these men will require or desire surgery. For those with bothersome symptoms self-management may be an effective strategy. Self-management interventions include education, reassurance, fluid management, caffeine avoidance, rescheduling concurrent medications and bladder retraining. As in other chronic disease areas such as diabetes and arthritis for which self-management is well established, lifestyle and behavioural interventions for men with lower urinary tract symptoms aim to allow the patient some day-to-day control over their symptoms. These interventions have been shown to be in wide use in the UK without good quality supporting evidence, suggesting that they are thought to be safe and effective.

Summary Self-management (lifestyle and behavioural) interventions provide men with some control over their symptoms, their role as either a primary treatment strategy or to augment pharmacotherapy has yet to be defined.

aClinical Effectiveness Unit, The Royal College of Surgeons of England and bInstitute of Urology and Nephrology, London, UK

Correspondence to Mr Christian T. Brown, Urological Research Fellow, The Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK Tel. +44 20 7869 6606; fax: +44 20 7869 6644; e-mail: cbrown@rcseng.ac.uk

© 2004 Lippincott Williams & Wilkins, Inc.