URINARY SYMPTOMS IN OLDER MEN, THEIR INVESTIGATION AND MANAGEMENT - IS THERE AN EPIDEMIC OF UNDETECTED MORBIDITY IN THE WAITING ROOM

As in other developed countries with an ageing population, there is a growing perception in Australia that urinary symptoms are a major caus e of morbidity among older men. This study aimed to determine the prev alence of urinary symptoms amongst male patients in general practice, their presentation, investigation and management. Randomly selected ge neral practitioners' (GPs') surgeries in five mainland state capital c ities in Australia were involved. A consecutive sample of male patient s aged 50 yea rs a nd over was asked to complete a self-administered q uestionnaire about urinary symptoms, allowing a symptom score to be ca lculated. For each participating patient, GPs completed a checklist ab out symptoms, investigation and management without knowledge of the pa tient's answers. Sixty-eight per cent of GPs agreed to participate in the study and 95% of patients participated, resulting in 4268 patient questionnaires and 4255 GP checklists. Men bothered by severe symptom scores were significantly more likely than men with mild symptoms to b e presenting with a urinary problem. For no city did the proportion of men with severe symptom scores who were not presenting for a urinary problem exceed 7%. Other measures of morbidity were similarly low in t his group. GPs investigated 61% of urological symptoms presenting on t he day and initiated treatment for less than a third. Approximately 10 % of the total sample had had a transurethral resection of the prostat e: 9% of these had severe symptom scores. It was concluded that almost all older men in general practice who are sufficiently troubled by ur inary symptoms will see their GP for advice at some time. The majority of urological problems appear to be managed conservatively by GPs. Gi ven the expansion of available treatments and the inevitable limitatio ns of each, GPs might consider a self-administered questionnaire as an objective measure of urinary symptoms to, tailor treatment choices an d to monitor their impact on patient outcomes.