Self-Management for Men With Lower Urinary Tract Symptoms

A Systematic Review and Meta-Analysis

Loai Albarqouni, MD, MSc, PhD; Sharon Sanders, PhD; Justin Clark, BA; Kari A. O. Tikkinen, MD, PhD; Paul Glasziou, MBBS, PhD

Disclosures

Ann Fam Med. 2021;19(2):157-167. 

In This Article

Abstract and Introduction

Abstract

Purpose: Lower urinary tract symptoms are very common in older men. We conducted a systematic review and meta-analysis to evaluate the effects of self-management interventions on these symptoms.

Methods: We included randomized controlled trials comparing the effect of self-management interventions (alone or combined with drug therapy) with usual care or drug therapy alone in men with lower urinary tract symptoms. Two independent reviewers screened retrieved articles, extracted data, and assessed the risk of bias of included studies. The primary outcome was lower urinary tract symptom severity. Where data were available, we calculated mean differences (MDs) between the interventions.

Results: Analyses were based on 8 studies among 1,006 adult men. Seven of these studies were judged to be at high risk in 2 of the 7 domains of bias. The nature of the self-management interventions varied across studies. There was a clinically important reduction in the 35-point International Prostate Symptom Score at 6 months favoring self-management interventions compared with usual care (MD = −7.4; 95% CI, −8.8 to −6.1; 2 studies). The reduction in score with self-management was similar to that achieved with drug therapy at 6 to 12 weeks (MD = 0.0; 95% CI, −2.0 to 2.0; 3 studies). Self-management had a smaller, additional benefit at 6 weeks when added to drug therapy (MD = −2.3; 95% CI, −4.1 to −0.5; 1 study).

Conclusions: We found moderate-quality evidence (suggesting reasonable certainty in estimates) for the effectiveness of self-management for treating lower urinary tract symptoms in men. We therefore recommend the use of self-management interventions for this patient population.

Introduction

Lower urinary tract symptoms are a common problem among older men,[1] affecting 70% to 90% of those aged 80 years and older.[2,3] These symptoms can be divided into storage symptoms (eg, increased urinary frequency, urgency, nocturia, incontinence), voiding symptoms (eg, hesitancy, poor stream, incomplete emptying, dribbling), and postmicturition symptoms.[4] Male lower urinary tract symptoms have traditionally been related to bladder outlet obstruction, which is often caused by prostatic enlargement resulting from benign prostatic hyperplasia (BPH). An increasing number of studies have shown, however, that these symptoms are often unrelated to the prostate.[5,6] Indeed, they can be caused by various conditions within or outside the lower urinary tract, including detrusor overactivity or underactivity, and urethral diseases.[7] Although voiding symptoms are the most common, they are generally less bothersome than storage symptoms, which are the most typical reason men seek medical care.[8,9] Lower urinary tract symptoms can have a substantial negative impact on quality of life,[10] including impaired social functioning[11] and sleep disturbance from nocturia.[12]

Self-management interventions are "structured interventions aimed at improving individual's medical, behavioral, and emotional condition in order to give individuals some control over their symptoms."[13–15] Brown et al,[16] through a formal consensus process, defined main components of self-management interventions for lower urinary tract symptoms in men. Most cases can be effectively managed in primary care[1] with a stepwise management approach (ie, usual care), beginning with watchful waiting and progressing to drug and surgical interventions if necessary.[6] Although several guidelines for managing lower urinary tract symptoms in men recommend self-management as one of several treatment options such as watchful waiting,[6,8] self-management interventions are rarely considered a definitive treatment option. These interventions only occasionally appear in patient decision aids. For instance, the widely used and respected Ottawa Hospital Research Institute catalog of patient decision aids (https://decisionaid.ohri.ca) lists 3 patient decision aids for treating lower urinary tract symptoms, but none of these appear to consider self-management interventions.

We are unaware of any previous systematic reviews synthesizing the evidence for the effect of self-management interventions in men with lower urinary tract symptoms. Existing reviews have evaluated the effect of self-management interventions on specific symptoms only (eg, urinary incontinence), focused on general lifestyle interventions such as physical activity, and included both men and women.[17–20] Recently, a scoping review was conducted to inform the development of an online personalized self-management intervention for men with lower urinary tract symptoms, and it identified few studies of self-management interventions; moreover, no quantification or pooling of their effects was conducted.[21] We therefore undertook a systematic review of randomized controlled trials (RCTs) that have compared self-management interventions with either control/usual care or drug therapy for reducing lower urinary tract symptoms among adult men.

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