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Publication - Dr Jeremy Horwood

    Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms

    Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM)

    Citation

    Lewis, A, Young, G, Abrams, P, Blair, P, Chapple, C, Glazener, C, Horwood, J, McGrath, J, Noble, S, , Lane, JA & Drake, M, 2019, ‘Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM)’. European Urology Focus.

    Abstract

    Background: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies).

    Objective: Report the participant sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are non-inferior and surgery rates are lower if UDS is included.

    Design, Setting, and Participants: 820 men (≥18-years) seeking treatment for bothersome LUTS recruited from 26 NHS hospital urology departments.
    Intervention: Care pathway based on routine, non-invasive tests (control) or routine care plus UDS (intervention arm).

    Outcome Measurements: Primary outcome is International Prostate Symptom Score (IPSS) and key secondary outcome is surgery rates, 18-months after randomisation. International Consultation on Incontinence Questionnaires (ICIQ) were captured for MLUTS, sexual function and UDS satisfaction.

    Statistical Analysis: Baseline clinical and patient reported outcomes (PROMs), and UDS findings, were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick’s test and questionnaire items compared using Pearson’s correlation coefficient.

    Results and Limitations: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia and erectile dysfunction and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS expressed high satisfaction with the procedure.

    Conclusions: Men being considered for surgery have additional clinical features that may affect treatment decision-making and outcomes, notably storage LUTS and impaired sexual function.

    Full details in the University publications repository