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Objective: To assess predictors of failure of medical treatment of lower urinary tract symptoms (LUTS) and evaluate long-term outcome. Methods: Between January 1993 and September 1994, 178 men referred with LUTS were prospectively recruited. Assessments included maximum urine flow (Qmax), postvoiding residuals (PVR), transrectal ultrasound (TRUS) prostate volumes, American Urological Association symptom score, and validated quality of life (QOL) and bother scores. Treatment failure was defined as need for transurethral resection of the prostate (TURP). Data were collected at baseline, with final follow-up at 12 years. Univariate and multivariate analyses used Kaplan-Meier and the Cox proportional hazards regression model, respectively, to assess covariates on risk of failure and independent variable prognostic values. Results: Median follow-up was 7.9 years (range, 0-12 years). The mean QOL baseline score of 7.1 improved to 3.6 at 6 years and to 3.3 at 12 years (P <.05 for all). Fifty patients (28%) underwent TURP, with 36 undergoing TURP within 3 years. By univariate analysis, Qmax, AUA and bother scores, and PVR were significantly associated with treatment failure. Independent predictors of failure by multivariate Cox regression were Qmax (>15 vs <15 mL/s; hazard ratio, 3.37; 95% confidence interval, 1.74-6.52; P <.0001) and bother score (<13 vs >13; hazard ratio, 2.37; 95% confidence interval, 1.29-4.35; P = .005). At 12 years, AUA, QOL, and bother scores statistically improved compared with baseline (13 vs 8, 10 vs 6, and 5 vs 2, respectively). Limitations included attrition bias from nonresponders. Conclusion: The beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores. [ABSTRACT FROM AUTHOR]

Objectives: To assess the long-term clinical effectiveness, quality of life (QOL), bother, and satisfaction, using validated questionnaires, after transurethral resection of the prostate in patients with lower urinary tract symptoms due to benign prostatic enlargement. Methods: We enrolled men referred to a tertiary university hospital for further evaluation and treatment of lower urinary tract symptoms from January 1993 to September 1994 in a prospective cohort study. A total of 280 consecutive patients underwent transurethral resection of the prostate, mainly for outflow obstructive symptoms. They were recruited into this protocol-based study using validated self-reported questionnaires. The assessments included American Urological Association symptom score, flow rates, and measurement of QOL, bother, and satisfaction. The data were collected at baseline, 3 and 6 months, and 6 and 12 years of follow-up. Results: The mean QOL and bother score at baseline was 8.16 and 15.45, respectively. At 6 months, 6 years, and 12 years, the mean QOL and bother scores had improved to 2.54 and 4.84, 3.71 and 7.14, and 3.74 and 7.67, respectively. The improvements in the QOL and bother scores were consistent and statistically significant. Conclusions: Transurethral resection of the prostate not only proved to be clinically effective, but also improved patients'' QOL and bother symptoms. This was associated with long-term, high patient-rated satisfaction. [Copyright &y& Elsevier]

Objectives: To appraise the outcomes, determine the natural history, and instigate a rationale plan for follow-up of patients with asymptomatic dipstick hematuria. Methods: A total of 292 consecutive patients with asymptomatic dipstick hematuria referred between January1992 and December 1994 were investigated and prospectively followed up. The initial investigations included urinalysis, urine culture and sensitivity, cytology, intravenous urography, with or without ultrasonography, and cystoscopy. Baseline data and follow-up events, particularly the development of urologic malignancy, were recorded for a 13-year period. Results: Sixteen patients (5.4%) were found to have urologic malignancies on initial evaluation. Of these, 11 died. During a follow-up of 13 years, 21 patients (7%) were lost to follow-up and 42 died of various unrelated causes (other than urologic malignancies). Of the remaining 213 patients, 180 (84.5%) subsequently had negative urinalysis. None with negative urinalysis developed a urologic malignancy during follow-up. The presence of dipstick hematuria persisted in 33 patients. Of these 33 patients, 10 had nephrologic causes, 8 had urinary tract infection, and 15 underwent repeat investigation with no pathologic cause identified. One patient, discharged with negative findings after full initial investigations, presented 2 years later with frank hematuria and was found to have a new bladder tumor. Conclusions: Patients presenting with asymptomatic dipstick hematuria who have undergone thorough initial negative investigations can be discharged from tertiary urologic care services. Nephrologic referral is recommended if dipstick hematuria and proteinuria persist. The repetition of the urologic investigations is unwarranted, unless patients present with symptoms or develop frank hematuria. [Copyright &y& Elsevier]