Managing lower urinary tract symptoms in primary care: qualitative study of GPs' and patients' experiences

Background Lower urinary tract symptoms (LUTS) are common in males aged >= 40 years and have a considerable impact on quality of life. Management can be complex, and although most LUTS could be treated effectively in primary care, referrals to urology outpatients are increasing. Aim To explore GPs' experiences of managing LUTS together with patients' experiences of and preferences for treatment in primary care. Design and setting Telephone interviews were conducted with GPs and male patients presenting to primary care with bothersome LUTS. Method Eleven GPs and 25 male patients were purposively sampled from 20 GP practices in three UK regions: Newcastle upon Tyne, Bristol, and South Wales. Interviews were conducted between May 2018 and January 2019, and were analysed using a framework approach. Results Difficulty establishing causes and differentiating between prostate and bladder symptoms were key challenges to the diagnosis of LUTS in primary care, often making treatment a process of trial and error. Pharmacological treatments were commonly ineffective and often caused side effects. Despite this, patients were generally satisfied with GP consultations and expressed a preference for treatment in primary care. Conclusion Managing LUTS in primary care is a more accessible option for patients. Given the challenges of LUTS diagnosis, an effective diagnostic tool for use by GPs would be beneficial. Ensuring bothersome LUTS are not dismissed as a normal part of ageing is essential in improving patients' quality of life. Greater exploration of the role of non pharmacological treatments is needed.