Videourodynamic studies in men with lower urinary tract symptoms: A comparison of community based versus referral urological practices

Purpose: We compared the clinical and urodynamic characteristics of men ref erred for evaluation of lower urinary tract symptoms in community based ver sus referral urological practices and examined the various pathophysiologic al mechanisms of these symptoms. Materials and Methods: We reviewed a multicenter urodynamics database of 96 3 consecutive men referred for the evaluation of persistent lower urinary t ract symptoms at 2 community based and 1 urological referral center. Of the 963 patients in the database 422 (44%) were excluded from study due to neu rological disorder in 41%, previous urinary or pelvic surgery in 27% and th e use of medications known to affect voiding in 24%. A total of 541 patient s with a mean age plus or minus standard deviation of 64.4 +/- 13.8 years m et study inclusion criteria and were analyzed further. We compared the clin ical and urodynamic characteristics of patients at the community and referr al centers. Results: Lower urinary tract symptoms were equally common in men presenting to community and referral centers. The most common symptom was difficult v oiding, followed by frequency, urgency and nocturia in 58%, 54%, 43% and 40 % of the study population, respectively. Urodynamic diagnoses were also sim ilar in the 2 groups. Although bladder outlet obstruction was diagnosed in 69% of patients, it was the only urodynamic finding in a third of the patie nts with obstruction. The main concomitant urodynamic diagnoses were detrus or overactivity, bladder hyposensitivity, impaired detrusor contractility, low bladder compliance and bladder hypersensitivity in 47%, 10%, 10%, 9% an d 3% of obstructed cases, respectively. Conclusions: The pathophysiology of lower urinary tract symptoms in men is multifactorial, and similar at community practice and tertiary referral cen ters. The disparity in urodynamic findings and subjective symptoms emphasiz es the need for a thorough and early clinical and urodynamic evaluation.