BMJ, doi: 10.1136/bmj.39010.551319.AE, (Published 21 November 2006)

RESEARCH

Self management for men with lower urinary tract symptoms: randomised controlled trial

Christian T Brown ¹, Tet Yap ¹, David A Cromwell ², Lorna Rixon ³, Liz Steed ³, Kathleen Mulligan ³, Anthony Mundy ⁴, Stanton P Newman ³, Jan van der Meulen ^2*, Mark Emberton ⁴

¹ Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE
² Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
³ Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London
⁴ Institute of Urology, University College London, London W1W 7EY

^* Correspondence to: Jan.vanderMeulen{at}LSHTM.ac.uk.

Objective To evaluate the effectiveness of self management as a first line intervention for men with lower urinary tract symptoms.

Design Randomised controlled trial.

Setting A teaching hospital and a district general hospital in London.

Participants 140 men (mean age 63 (SD 10.7) years), recruited between January 2003 and April 2004, referred by general practitioners to urological outpatient departments with uncomplicated lower urinary tract symptoms.

Interventions Self management and standard care (n=73) or standard care alone (n=67). The self management group took part in three small group sessions comprising education, lifestyle advice, and training in problem solving and goal setting skills.

Main outcome measures The primary outcome measure was treatment failure measured at 3, 6, and 12 months. Symptom severity (international prostate symptom score; higher scores represent a poorer outcome) was used as a secondary outcome.

Results At three months, treatment failure had occurred in 7 (10%) of the self management group and in 27 (42%) of the standard care group (difference=32%, 95% confidence interval 18% to 46%). Corresponding differences in the frequency of treatment failure were 42% (27% to 57%) at six months and 48% (32% to 64%) at 12 months. At three months, the mean international prostate symptom score was 10.7 in the self management group and 16.4 in the standard care group (difference=5.7, 3.7 to 7.7). Corresponding differences in score were 6.5 (4.3 to 8.7) at six months and 5.1 (2.7 to 7.6) at 12 months.

Conclusions Self management significantly reduced the frequency of treatment failure and reduced urinary symptoms. Because of the large observed benefit of self management, the results of this study support the case for a large multicentre trial to confirm whether self management could be considered as first line treatment for men with lower urinary tract symptoms.

Trial registration National Research Register N0263115137; Clinical trials NCT00270309.

---

(Accepted 16 October 2006)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Benign prostatic hyperplasia. Part 2—Management

Timothy J Wilt and James N’Dow
BMJ 2008 336: 206-210. [Extract] [Full Text] [PDF]

US Highlights

Douglas Kamerow
BMJ 2007 334: 0. [Extract] [Full Text]

Lower urinary tract symptoms in men

Christopher R Chapple and Anand K Patel
BMJ 2007 334: 2. [Extract] [Full Text] [PDF]

Framework for design and evaluation of complex interventions to improve health

Michelle Campbell, Ray Fitzpatrick, Andrew Haines, Ann Louise Kinmonth, Peter Sandercock, David Spiegelhalter, and Peter Tyrer
BMJ 2000 321: 694-696. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Wilt, T. J, N'Dow, J. (2008). Benign prostatic hyperplasia. Part 2--Management. BMJ 336: 206-210 [Full text]  
• Ponieman, D., McGinn, T. (2007). Self management plus usual care was more effective than usual care alone for lower urinary tract symptoms in men. Evid. Based Med. 12: 73-73 [Full text]  
• (2007). Self-Management Helps Men with Lower Urinary Symptoms. JWatch General 2007: 2-2 [Full text]  
• Chapple, C. R, Patel, A. K (2007). Lower urinary tract symptoms in men. BMJ 334: 2-2 [Full text]  

Rapid Responses:

Read all Rapid Responses

Re: Self Management of Men with LUTS: A worthwhile option

TOLULOLA. O. TAIWO
bmj.com, 23 Nov 2006 [Full text]

Is intervention in small groups easily available?

Ramesh Munjal
bmj.com, 8 Jan 2007 [Full text]

Taking responsibility for your health

Kenneth A Hoekstra, PhD
bmj.com, 9 Jan 2007 [Full text]

Self-management in men with uncomplicated lower urinary tract symptoms: Does it really work?

Rasheed A Saad
bmj.com, 10 Jan 2007 [Full text]

Urinary Tract Symptoms in Men

Rosalind Maskell
bmj.com, 12 Jan 2007 [Full text]

Online poll

Find out more >>