Balancing the benefits and harms of drug treatments for older men with lower urinary tract symptoms

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5608 (Published 27 October 2015) Cite this as: BMJ 2015;351:h5608
  1. Timothy J Wilt123,
  2. Kristine E Ensrud134
  1. 1Minneapolis VA Center for Chronic Disease Outcomes Research—Section of General Medicine, Minneapolis, MN 55417, USA
  2. 2Minneapolis VA High Value Care Initiative
  3. 3University of Minnesota School of Medicine
  4. 4University of Minnesota School of Public Health—Division of Epidemiology and Community Health
  1. Correspondence to: T J Wilt tim.wilt{at}va.gov

Discussions with patients should include the small increase in risk of falls and fractures associated with selective α antagonists

Determining the value of a healthcare treatment requires balancing its benefits, harms, and costs.1 2 Findings from the study of Welk and colleagues3 add to our knowledge about the harms of selective α antagonists in older men with lower urinary tract symptoms (LUTS). Their results suggest that initiation of these medications is associated with modest increases in short term risks of injurious falls, fractures, and head trauma. How can doctors use these results to advance their understanding of lower urinary tract symptoms, and improve the value of treatments?

Among older men, LUTS due to benign prostatic hyperplasia are common, costly, and have a negative effect on quality of life.4 Treatment goals are to reduce bothersome symptoms and prevent clinical progression, including infrequent development of acute urinary retention and need for surgical intervention. Importantly, LUTS, especially nocturia, have been associated with a higher risk of falls.5

Prostate-selective and non-selective α antagonists provide similar symptomatic improvement in most men that begins within a month of treatment initiation.4 Many of these drugs are low cost. However, α antagonists do not prevent subsequent LUTS progression, including risk of acute urinary retention. In …

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