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The natural history of lower urinary tract dysfunction in men: Minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction

Thomas, Alun W.; Cannon, Andrea; Bartlett, Esther; Ellis-Jones, Julie; Abrams, Paul


Alun W. Thomas

Andrea Cannon

Esther Bartlett

Julie Ellis-Jones

Paul Abrams


OBJECTIVES: To assess the long-term outcomes of untreated bladder outlet obstruction (BOO), assuming that, if there is little or no deterioration, a conservative approach to management is justified, as there is little information on the natural history of untreated BOO and lower urinary tract symptoms (LUTS) in men, and studies to date suggest that neither BOO nor LUTS inevitably progress to a stage at which prostatectomy is required. PATIENTS AND METHODS: Men aged >45 years who were investigated in our department between 1972 and 1986, diagnosed with BOO, and who initially opted for no specific treatment were invited for repeat symptomatic and urodynamic evaluation. Identical methods of assessment were used, allowing results to be compared directly. RESULTS: In all, 1068 men were initially diagnosed with BOO; 428 (40%) of these died. Of the 170 men who initially opted for a conservative approach and attended for repeat assessment, 141 (83%) remained untreated, with a mean follow-up of 13.9 years. The only significant urodynamic changes were a reduction in detrusor contractility and an increased prevalence of detrusor overactivity. Most patients reported no change in their symptoms but a significant minority experienced a gradual deterioration. Of the 29 men in whom the conservative approach failed, 22 proceeded to surgery for LUTS, and seven for acute urinary retention. CONCLUSIONS: Patients with untreated BOO do not significantly deteriorate urodynamically in the long term, with only a minority deteriorating symptomatically. These findings justify a conservative approach to men with LUTS associated with BOO. © 2005 BJU International.


Thomas, A. W., Thomas, A. W., Thomas, A. W., Cannon, A., Bartlett, E., Ellis-Jones, J., & Abrams, P. (2005). The natural history of lower urinary tract dysfunction in men: Minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU International, 96(9), 1301-1306.

Journal Article Type Article
Publication Date Dec 1, 2005
Journal BJU International
Print ISSN 1464-4096
Electronic ISSN 1464-410X
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 96
Issue 9
Pages 1301-1306
Keywords lower urinary tract dysfunction, bladder outlet obstruction, urodynamics, natural history
Public URL