Mild LUTS associated with storage symptoms in men

Researchers from Taiwan have found that the International Prostate Symptom Score (IPSS) can differentiate between men with bladder storage dysfunction and those with bladder outlet disorders.

Patients with mild lower urinary tract symptoms (LUTS) predominantly presented with storage-predominant symptoms, while those with severe LUTS were much more likely to have bladder outlet disorders in association with storage symptoms, report Hann-Chorng Kuo (Buddhist Tzu Chi General Hospital, Hualien) and colleagues.

They studied 849 men with benign prostatic hyperplasia and symptomatic LUTS of a mean age of 66.9 years. Overall, 215 had mild LUTS (IPSS ≤7), 461 had moderate LUTS (IPSS 8–19) and 173 had severe LUTS (IPSS ≥20).

The team found that the ratio of IPSS voiding to storage subscale scores (IPSS-V/S) increased with LUTS severity at 0.75 in those with mild LUTS, 1.83 in moderate LUTS and 1.88 in severe LUTS. An IPSS-V/S of 1.0 or less, indicating storage-dominant dysfunction, was present in 81.4% of patients with mild LUTS, while in those with severe LUTS, 71.1% had an IPSS-V/S of greater than 1.0, indicating voiding-dominant dysfunction.

And when 407 men were treated for 1 month according to IPSS-V/S ratio, alpha-blocker treatment in those with voiding-dominant LUTS and antimuscarinic treatment of patients with storage-dominant LUTS resulted in success rates of 84.0% and 88.8%, respectively, in patients with mild LUTS. However, the team notes that therapeutic success decreased in patients with moderate LUTS (64.9 and 63.8%, respectively) and severe LUTS (50.0 and 33.3%, respectively).

Similarly, after 3 months of treatment, the majority of patients with mild and moderate LUTS had a satisfactory outcome while patients with severe LUTS did not.

Writing in the International Journal of Clinical Practice, Kuo et al say the findings indicate that the IPSS-V/S ratio is an effective way to guide treatment, but it has limitations.

“Men with mild and moderate LUTS can be treated based on their IPSS-V/S ratios, but men with severe LUTS should not.

“Instead, they should undergo thorough urological examinations before treatment selection to obtain favourable treatment results,” the team conclude.

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