Urinary Symptoms in Older Men, Their Investigation and Management: is there an Epidemic of Undetected Morbidity in the Waiting Room?

Abstract

As in other developed countries with an ageing population, there is a growing perception in Australia that urinary symptoms are a major cause of morbidity among older men. This study aimed to determine the prevalence of urinary symptoms amongst male patients in general practice, their presentation, investigation and management. Randomly selected general practitioners' (GPs') surgeries in five mainland state capital cities in Australia were involved. A consecutive sample of male patients aged 50 years and over was asked to complete a self-administered questionnaire about urinary symptoms, allowing a symptom score to be calculated. For each participating patient, GPs completed a checklist about symptoms, investigation and management without knowledge of the patient's answers. Sixty-eight per cent of GPs agreed to participate in the study and 95% of patients participated, resulting in 4268 patient questionnaires and 4255 GP checklists. Men bothered by severe symptom scores were significantly more likely than men with mild symptoms to be presenting with a urinary problem. For no city did the proportion of men with severe symptom scores who were not presenting for a urinary problem exceed 7%. Other measures of morbidity were similarly low in this group. GPs investigated 61% of urological symptoms presenting on the day and initiated treatment for less than a third. Approximately 10% of the total sample had had a transurethral resection of the prostate: 9% of these had severe symptom scores. It was concluded that almost all older men in general practice who are sufficiently troubled by urinary symptoms will see their GP for advice at some time. The majority of urological problems appear to be managed conservatively by GPs. Given the expansion of available treatments and the inevitable limitations of each, GPs might consider a self- administered questionnaire as an objective measure of urinary symptoms to tailor treatment choices and to monitor their impact on patient outcomes.