Michael E. Albo, MD, FACS, presented “LUTS: Latest in Prevention, Clinical Trials, and Approved Treatments” during the 29th Annual Perspectives in Urology: Point-Counterpoint, on November 18, 2021, in Coronado Island, San Diego, California.
How to cite: Albo, Michael E. “LUTS: Latest in Prevention, Clinical Trials, and Approved Treatments.” November 18, 2021. Accessed Dec 2024. https://grandroundsinurology.com/luts-latest-in-prevention-clinical-trials-and-approved-treatments/
LUTS: Latest in Prevention, Clinical Trials, and Approved Treatments
Michael E. Albo, MD, Vice Chair of the Department of Urology at the University of California, San Diego, gives an overview of how to assess and treat lower urinary tract symptoms (LUTS) in men. He presents a case of a 65-year-old patient referred to a urologist due to benign prostatic hyperplasia (BPH). Dr. Albo explains that in the old treatment algorithm, the question of how to treat this patient would have been simple: urinary symptoms would be treated with a non-specific Alpha blocker, and then if symptoms persisted, the urologist would offer transurethral prostatectomy (TURP) or a simple prostatectomy. However, Dr. Albo notes, the updated treatment algorithm currently in use is far more complex and features many options. This is due in part, he observes, to the realization that LUTS is not just related to the prostate, but rather has a complicated etiology related to other parts of the body including the bladder and urinary tract. Dr. Albo returns to the example of the 65-year-old referred for BPH, and explains that based on the new algorithm, initial evaluation of this patient will likely feature taking his medical history, giving him a physical examination, getting his International Prostate Symptom Score (IPSS), performing urinalysis, having him keep a 3-day voiding diary, and counseling him on options for intervention. Dr. Albo explains that determining prostate size is important as well since volume predicts symptom progression and risk of complications, and can inform treatment selection. He also observes that when selecting a treatment, a treatment’s effect on sexual function is an important factor for most men, regardless of age. Dr. Albo then lists additional suggested evaluation techniques for patients with LUTS, including assessment of prostate size and shape, checking post-void residual (PVR) volume, and performing uroflowmetry and urodynamic testing. He notes that none of these has enough data to prove they should be used in everybody. Dr. Albo moves on to how to treat LUTS, explaining that the goals of treatment include alleviation of bothersome symptoms, prevention of complications, prevention of progression, and minimization of complications of treatment. He discusses watchful waiting for LUTS, highlighting that 85% of men with mild LUTS are stable at one year, but 36% of men with moderate LUTS cross over to surgery within 5 years. Dr. Albo concludes that the complicated new guidelines are helpful, but far from where they need to be.
About the 29th Annual Perspectives in Urology: Point Counterpoint conference:
Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Michael E. Albo, MD, is a board-certified urologist specializing in voiding dysfunction, urinary incontinence, urodynamics, female urology, pelvic floor reconstruction, and urogenital conditions caused by neurologic disorders. Dr. Albo's expertise includes performing pelvic floor reconstruction surgeries in both women and men; surgery for urinary incontinence; neuromodulation; and botulinum toxin (Botox) injections. He is also trained in a wide variety of medical and surgical techniques to manage voiding disorders and prostate disorders in men.
Dr. Albo is the founder of UC San Diego Health's Women's Pelvic Medicine Center (WPMC). The WPMC is San Diego's only multi-specialty clinic dedicated to the evaluation and treatment of female pelvic floor disorders.
Additionally, Dr. Albo is a professor in the University of California, San Diego, Department of Urology and the vice-chair of the Division of Urology, where he instructs medical students, residents and fellows. He has co-authored over 25 peer-reviewed articles and his work has appeared in The Journal of Urology, The New England Journal of Medicine and The American Journal of Obstetrics and Gynecology.
Dr. Albo completed his fellowship training at UCLA School of Medicine and residencies in general surgery and urology at University of Virginia School of Medicine. He earned his medical degree from the University of Utah School of Medicine. Dr. Albo is a fellow of the American College of Surgeons (FACS) and is board certified in urology and female pelvic medicine and reconstructive surgery.
He is a member of many national and local medical societies. Dr. Albo is consistently elected as one of San Diego's Top Doctors through San Diego Magazine's "Physicians of Exceptional Excellence" annual survey performed in collaboration with the San Diego County Medical Society.
