Most bothersome symptom and symptom specific goal achievement in patients with benign prostatic obstruction: a prospective open label study

Purpose: We evaluated symptom specific goal achievement, and the correlations between goal achievement and traditional outcome measures after pharmacological therapy in patients with benign prostatic obstruction.

Materials and methods: Men 50 years old or older with lower urinary tract symptoms secondary to benign prostatic obstruction and International Prostate Symptom Score 8 or greater were enrolled and treated with 10 mg alfuzosin XL for 12 months. Before treatment, face-to-face interviews were conducted to identify the single most bothersome symptoms and to set treatment goals for the symptoms in individual patients. After treatment, patients described perceptions of goal achievement using a 5-point Likert scale. Changes in International Prostate Symptom Score/quality of life score, International Continence Society male short form questionnaire, 3-day voiding diary and uroflowmetry parameters were analyzed to evaluate the correlations between goal achievement and traditional outcome measures.

Results: Of 108 most bothersome symptoms slow stream (26.9%) was the most frequently reported followed by increased daytime frequency (21.3%) and nocturia (19.4%). After treatment the median score of goal achievement was 3 points with no significant difference among most bothersome symptoms. Changes in quality of life score (correlation coefficient -0.247, p=0.020) and maximal flow rate (correlation coefficient 0.254, p=0.021) were correlated with goal achievement. For men with most bothersome symptoms of storage, changes in the number of micturition and urgency episodes per 24 hours were correlated with goal achievement. For men with most bothersome symptoms of voiding the International Prostate Symptom Score voiding score was correlated with goal achievement.

Conclusions: Assessing goal achievement for most bothersome symptoms can be a useful outcome measure in patients with benign prostatic obstruction with heterogeneous symptoms or goals reflecting change in quality of life.