Conservative intervention reduces LUTS in men

Use of a standardized and manualized intervention in a primary care setting results in a sustained decrease in lower urinary tract symptoms (LUTS) in men compared with usual care, results of the TRIUMPH study have shown.

“This study developed a standardized and manualized intervention that provided a practical resource to support symptom assessment and conservative treatment for LUTS in men in primary care,” according to the investigators.

The difference in mean International Prostate Symptom Score (IPSS) at 12 months was ‒1.81 points (95 percent confidence interval [CI], ‒0.95 to ‒2.66), which was less than the predefined target reduction of 2.0 points. [BMJ 2023;383:e075219]

This cluster randomized controlled trial was conducted in 30 National Health Service general practice sites in England. Of the 1,077 men (aged ≥18 years) with bothersome LUTS who were recruited between June 2018 and August 2019, 524 were assigned to the intervention arm (n=17 sites) and 533 to the usual care arm (n=13 sites).

Participants received a standardized information booklet developed with expert and patient input to provide guidance on conservative and lifestyle interventions. After assessment of urinary symptoms, nurses and healthcare assistants guided patients to relevant sections of the manual and provided contact over 12 weeks to assist with adherence.

At 12 months, the mean IPSS was lower among participants in the intervention arm (adjusted mean difference, ‒1.81 points, 95 percent CI, ‒2.66 to ‒0.95), suggesting less severe symptoms than those in the usual care arm. The intervention arm also achieved improvements in LUTS-specific quality of life, incontinence, and perception compared with the usual care arm.

Additionally, no significant between-group differences were observed in terms of urology referrals (7.3 percent vs 7.9 percent) and adverse events (seven vs eight events).

Primary care

A nonrandomized pilot study of men with uncomplicated LUTS in secondary care provided an online self-management program in the intervention arm relative to usual care from a urologist. Results showed no significant differences in IPSS between the two groups. In addition, acceptance of the intervention stood at only 53 percent. [Neurourol Urodyn 2019;38:2273-2279]

Another randomized trial explored the effects of a health education strategy on older adults living at home. Participants received a booklet on five common health problems, including LUTS. However, this approach failed to translate to a doctor visit within 3 months. [Patient Educ Couns 2004;55:48-54]

These two studies suggested that primary care is the proper setting to support self-care in LUTS, the investigators noted.

“Future research will be directed at integrating the TRIUMPH intervention into general practice infrastructure, adapting it for patients with low literacy or whose first language is not English, including training materials, approaches to interpretation, and access to the standardized booklet,” the investigators said.

“Potentially, many of the symptoms managed in this way are also experienced by women, raising the possibility of developing an equivalent standardized and manualized approach to managing LUTS in female patients,” they added.