van der Meulen J et al. (2007) Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ 334: 25–28

Standard treatment for men with lower urinary tract symptoms (LUTS) begins with watchful waiting and escalates through a range of drugs to surgery. Lifestyle modification is also routinely advised. To investigate the effectiveness of self-management as first-line treatment in men with LUTS, van der Meulen et al. devised an intervention that aimed to reduce urinary symptoms and delay treatment.

This randomized, controlled trial included 140 men with uncomplicated LUTS. The patients were randomly assigned to standard care alone (n = 67), or to attend a self-management program in addition to standard care (n = 73). The self-management group participated in three small-group sessions (weeks 1, 2 and 6 after randomization), in which they were taught problem-solving and goal-setting techniques to modify their lifestyle and behavior. Patients were followed up at 3, 6 and 12 months to assess their LUTS and to determine whether drug therapy or surgery had become necessary (treatment failure).

Treatment failure was more frequent in patients who received standard care alone than in self-managed patients at 3, 6 and 12 months (difference 32%, 42% and 48%, respectively). Patients in the self-management group had a better quality of life and were less troubled by their LUTS than patients who received standard care alone.

The authors conclude that self-management could potentially become an ideal first-line treatment for men with LUTS. A large, multicenter, randomized controlled trial should, however, be carried out to determine whether these results could be applied to everyday clinical practice.