Estimating a population's needs for the treatment of lower urinary tract symptoms in men: what is the extent of unmet need?

BACKGROUND: Prevalence surveys have shown that men aged over 40 commonly experience lower urinary tract symptoms (LUTS). However, such studies cannot be used in isolation to inform health service planning, as not all men are troubled by their symptoms nor would they necessarily benefit from treatment.
METHODS: A total of 3,540 randomly selected men in Somerset were sent a postal questionnaire containing the American Urological Association (AUA) symptom index. Men reporting moderate or severe symptoms were invited for clinical assessment to determine whether they could benefit from treatment in primary or secondary care. The impact of their symptoms on their quality of life was measured using the ICS-QOL questionnaire.
RESULTS: The prevalence of reported LUTS was 256 per 1,000 men aged 40 and over. Of men reporting moderate or severe urinary symptoms, 40 per cent considered that they did not interfere with their life at all. The results were used to estimate the number of men with moderate or severe urinary symptoms, who could benefit from treatment and whose symptoms affected their quality of life. In a population of 250,000, 482 men [95 per cent confidence interval (CI) 263-704] could benefit from treatment in secondary care, and 3,557 men could be managed in primary care through watchful waiting or medical intervention (95 per cent CI 2,935-4,182).
CONCLUSIONS: The majority of men with LUTS in the community are not greatly troubled by them and are unlikely to benefit from treatment. This work can be used as a basis for planning the provision of services across primary and secondary care for the treatment of this common condition.