But standardised education in primary care practices did not lessen referrals to urology. 

Older men with lower urinary tract symptoms (LUTS) related to voiding or retention of urine often receive medications for prostatic hypertrophy or bladder dysfunction or are referred for urological evaluation. Lifestyle modification might be a useful first-line approach, but it has not been evaluated formally in a primary care setting.

In a cluster-randomised trial conducted in 30 UK primary care practices, 1000 symptomatic men (mean age, 68 years) who had reported LUTS in the previous five years and had not undergone surgery were randomised to usual care or a standardised lifestyle modification program. Patients in the intervention arm met with a trained nurse or healthcare assistant who provided a booklet about lifestyle modifications for LUTS (e.g. fluid restriction, pelvic floor exercises, sleep hygiene) and gave individualised instruction. Follow-up contacts occurred one, four and 12 weeks later.

At baseline, mean scores on the widely used 35-point International Prostate Symptom Score (IPSS) scale of prostate symptom severity was about 14 in both groups. Twelve months later, the average adjusted score was 1.8 points lower in the intervention group than in the control group; the difference was statistically significant but less than the prespecified minimally clinically important difference of two points. Referrals to urology did not differ between arms.

Comment: Without trained assistants, time-constrained US providers might struggle to replicate this intervention. Nevertheless, motivated patients and providers might find the study booklet useful – it is available online.

Bruce Soloway, MD, Associate Professor Emeritus of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Drake MJ, et al. Treatment of lower urinary tract symptoms in men in primary care using a conservative intervention: cluster randomised controlled trial. BMJ 2023; 383: e075219.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.