Effect of tamsulosin hydrochloride on lower urinary tract symptoms and quality of life in patients with benign prostatic hyperplasia. Evaluation using bother score.

摘要

Benign prostatic hyperplasia (BPH) affects quality of life (QOL), and the goal of treatment is to improve lower urinary tract symptoms (LUTS), thus improving patient QOL. However, the international prostate symptom score (IPSS) used for evaluating LUTS does not always reflect the level of patient bother, and improvement in the IPSS score does not always reflect patient QOL. Therefore, in the present study, we observed the therapeutic effects of alpha(1)-blockers on IPSS, QOL index, and the bother score for individual symptoms. Ninety-three men diagnosed with BPH who had not yet been treated were enrolled (mean age 70 years). The IPSS, QOL index, and bother score for each symptom of IPSS (maximum 42 points, 7 grades, from 0 to 6: not at all bothersome, not bothersome, not much bother, neutral, a little bothersome, somewhat bothersome, very bothersome) were assessed in order to examine the correlation between LUTS and QOL. After treatment with tamsulosin hydrochloride 0.2 mg/day for 4 weeks, the change in each IPSS and bother score and the correlation was reassessed. Furthermore, the contribution of improvements in each symptom score and bother score to improvement in QOL index was examined using a path analysis model. On the IPSS at initial evaluation, the score was highest for slow stream. The bother scores were high for slow stream, nocturia, and daytime frequency. For slow stream, patients with a high IPSS score also had a high bother score, but for nocturia, there was a large discrepancy between the IPSS and bother score. After treatment, total IPSS, QOL and total bother scores were significantly improved (p <0.01). Improvements in all individual symptom scores and bother scores were also observed (p <0.01). The most predictable symptom for improvement in QOL after treatment was the improvement in the bother score for nocturia (F test; p <0.01). Treatment with tamsulosin hydrochloride showed significant improvement of each IPSS and the bother score. For nocturia, there was a large discrepancy between the IPSS and bother score. After treatment, the improvement in bother score for nocturia showed the strongest contribution to improvement in QOL. The present study suggests that in addition to the IPSS, the evaluation of bother score for each symptom may be necessary in the management for patients with LUTS suggestive of BPH.