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Key Messages Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45–49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.

Objectives To determine the incidence of ‘burnout’ among UK and Irish urological consultants and non-consultant hospital doctors (NCHDs). The second objective was to identify possible causative factors and to investigate the impact of various vocational stressors that urologists face in their day-to-day work and to establish whether these correlate with burnout. The third objective was to develop a new questionnaire to complement the Maslach Burnout Inventory (MBI), more specific to urologists as distinct from other surgical/medical specialties, and to use this in addition to the MBI to determine if there is a requirement to develop effective preventative measures for stress in the work place, and develop targeted remedial measures when individuals are affected by burnout. Subjects and methods A joint collaboration was carried out between the Irish Society of Urology (ISU) and the British Association of Urological Surgeons (BAUS). Anonymous voluntary questionnaires were sent to all current registered members of both governing bodies. The questionnaire comprised two parts: the first part encompassed sociodemographic data collection and identifying potential risk factors for burnout, and the second used the MBI to objectively assess for workplace burnout. To evaluate differences in burnout, 2 × 2 contingency tables and Fischer's exact probability tests were used. Results In all, 575 urologists responded to the online survey out of a total of 1380 invites, yielding a 42% response rate. All respondents were aged

The efficacy and safety of a new tablet formulation of tamsulosin (the oral-controlled absorption system: OCAS®) have been assessed in several clinical trials. In a phase IIb and a phase IIIa trial, the appropriate dose of the tamsulosin tablet for clinical practice was determined. All tested doses of tamsulosin OCAS (0.4, 0.8 and 1.2 mg) improved the lower urinary symptoms (LUTS) of benign prostatic enlargement to a statistically significantly greater extent than placebo, with no differences between the doses. However, treatment with tamsulosin OCAS 0.4 mg was associated with a lower incidence of treatment-emergent adverse events (AEs) than the 0.8 mg and 1.2 mg doses. The incidence of the two most frequently reported AEs, dizziness and abnormal ejaculation, was similar for tamsulosin OCAS 0.4 mg and placebo. As the 0.4 mg tablet had the most favourable efficacy/safety profile, it was selected as the most appropriate dose to use in further clinical research studies. In a phase IIIb trial, the 0.4 mg dose of tamsulosin OCAS improved nocturia, quality of sleep and quality of life. Cardiovascular safety studies showed that tamsulosin OCAS 0.4 mg has a better cardiovascular safety profile, even under conditions that stress the cardiovascular system and in older people. Overall, these studies confirm the assumption that the improved pharmacokinetics of tamsulosin OCAS together with tamsulosin’s α1A-/α1D-adrenoceptor subtype selectivity and its selective distribution to the LUT, translate into a superior safety profile.

As my Comment in the first section of the journal suggested, the MTOPS results have offered the possibility to general practitioners of reducing the risk of side-effects of BPH, particularly urinary retention, by giving patients dual therapy with 5α-reductase inhibitor and alpha-adrenergic blocker. Authors from the UK present guidelines for the primary case management of male LUTS, which significantly fills this gap in the literature. Any help in the management of chronic nonbacterial prostatitis is welcome to clinicians; many treatments have been proposed after non-comparative trials, and so their value must be viewed cautiously. The authors from Canada and USA present the results of a randomized placebo-controlled study into the use of finasteride in such patients. The other papers in this section all deal with LUTS, e.g. frequency and nocturia, in a variety of situations. There is still great interest in the epidemiology of these symptoms, and in the various methods of grading their severity.

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45-49 years, rising to30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.

Objective To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP). Patients and methods A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a ‘free-paint’ application of 60 W Nd:YAG coagulation energy. Patients were re-assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods. Results In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P

Objective To evaluate the efficacy and safety in a dose-ranging study of tamsulosin (once-daily) as a modified-release formulation compared with placebo in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic obstruction (BPO), and to establish the optimum dosage for phase III clinical studies. Patients and methods Of 169 patients with LUTS associated with BPO enrolled in a 3 week placebo run-in period, 126 were subsequently randomized to receive placebo (28), or 0.2 mg (35), 0.4 mg (30), or 0.6 mg (33) of tamsulosin once daily for 4 weeks. Free-flow and pressure-flow measurements, and modified Boyarsky symptom scores were used to determine efficacy. Safety was evaluated by monitoring adverse events and vital signs (including 8 h after the first dose), and by laboratory determinations. Results Tamsulosin 0.4 mg and 0.6 mg produced significantly greater improvements in maximum urinary flow rate (Qmax ) (2.2 mL/s, 22.6%, and 1.8 mL/s, 20.2%, respectively) than did placebo (−0.1 mL/s, −0.9%). The results from the pressure-flow studies confirmed the results for Qmax in the free flow studies, with optimum and significant effects for tamsulosin 0.4 mg. This also applied for detrusor pressure at maximum flow, which decreased by 26.6 cmH2O (−28.2%) on 0.4 mg tamsulosin whereas it increased by 4.9 cm H2O (5.7%) on placebo. The greatest reductions in total symptom score were obtained with tamsulosin 0.4 mg and 0.6 mg (4.1, −28.7%, and 4.4 points, −28.2%, respectively) compared with reductions of 3.4 (−20.1%) in the tamsulosin (0.2 mg) and 2.9 points (−17.7%) in the placebo groups. The difference in effects on total symptom score between treatment groups was not statistically significant, which can be attributed to the small sample size. Tamsulosin was well tolerated; at least one adverse event was reported by 29%, 23%, 27% and 36% of patients in the placebo and tamsulosin 0.2 mg, 0.4 mg and 0.6 mg groups, respectively. There were no apparent tamsulosin dose-dependent changes in vital signs from baseline to the end of 4 weeks of randomized treatment. Tamsulosin caused no statistically significantly greater changes in blood pressure than placebo during the initial 8 h after the first dose. There were no clinically significant changes in laboratory variables. Conclusion Tamsulosin is well tolerated and effective in improving urinary flow and relieving LUTS associated with BPO. Optimal effects are achieved with tamsulosin 0.4 mg administered once daily.

To examine the role of pelvic floor exercises as a way of restoring erectile function in men with erectile dysfunction.In all, 55 men aged20 years who had experienced erectile dysfunction foror = 6 months were recruited for a randomized controlled study with a cross-over arm. The men were treated with either pelvic floor muscle exercises (taught by a physiotherapist) with biofeedback and lifestyle changes (intervention group) or they were advised on lifestyle changes only (control group). Control patients who did not respond after 3 months were treated with the intervention. All men were given home exercises for a further 3 months. Outcomes were measured using the International Index of Erectile Function (IIEF), anal pressure measurements and independent (blinded) assessments.After 3 months, the erectile function of men in the intervention group was significantly better than in the control group (P0.001). Control patients who were given the intervention also significantly improved 3 months later (P0.001). After 6 months, blind assessment showed that 40% of men had regained normal erectile function, 35.5% improved but 24.5% failed to improve.This study suggests that pelvic floor exercises should be considered as a first-line approach for men seeking long-term resolution of their erectile dysfunction.