Lower urinary tract symptoms in men: management

Why this is important

This research would clarify whether this test could improve the outcome of surgery. By identifying which patients had bladder outlet obstruction, it could improve the chance of a good outcome from surgery. The study should be a randomised controlled trial comparing multichannel cystometry before surgery with no intervention in men waiting to have bladder outlet surgery.

Why this is important

The number of patients in this group is steadily increasing as the population ages and more radical prostatectomies are carried out. Current practice varies widely across the UK with no established standard of good practice. This research could establish the best approach to management in these men and so bring more effective, patient-focused treatment that is more cost effective. The study should be a randomised controlled trial comparing intermittent catheterisation, indwelling suprapubic and indwelling urethral catheterisation. Outcomes of interest would be quality of life, healthcare resource use and adverse events (including leakage, skin breakdown, infection, erosion and death).

Why this is important

The number of patients in this group is steadily increasing as more radical prostatectomies are carried out and the population ages. Current practice varies widely across the UK with no established standard of good practice. This research could establish the best approach to continence management in these men and so provide more effective, patient-focused treatment that is more cost effective. In current non-specialist practice, bladder training is often not considered, and adequate diagnosis and hence optimal treatment of bladder dysfunction is often not implemented. Evidence-based guidance on selecting the most suitable containment product and its subsequent management will increase the quality of life of patients, use skilled nurse or carer resources more efficiently and reduce the costs of waste of unsuitable or sub-optimal product use. The study should be a randomised controlled trial reporting symptom severity, quality of life, changes in measured leakage and occurrence of adverse events.

Why this is important

Guidance is needed on the most suitable surgical options for this growing group of men who, until recently, have had no acceptable treatment option other than insertion of an artificial urinary sphincter. Many men consider insertion of an artificial sphincter to be too invasive and too prone to complication or failure, and therefore depend on containment alone for control of their urinary incontinence. A number of new interventions have been devised but it is uncertain which of these offers the best outcomes. This research could lead to clear recommendations and effective treatment for the majority of these men. A randomised controlled trial is recommended, comparing up to three current interventions: retrobulbar 'non-compressive' male sling, adjustable compression sling, and implanted adjustable compression device.

Why this is important

There is a gap in the evidence about the effectiveness of PDE5Is in men with LUTS who do not have erectile dysfunction. The current evidence includes men with LUTS and erectile dysfunction. Therefore, the standing committee decided that it was not appropriate to make a recommendation about the routine use of PDE5Is in clinical practice. More evidence is needed to enable a recommendation to be made on the use of PDE5Is in all men with LUTS, including those without erectile dysfunction. The study should be a randomised controlled trial comparing PDE5Is with usual care in men over 45 years with LUTS without erectile dysfunction. Outcomes should include the International Prostate Symptom Score (IPSS) symptom score, IPSS quality of life, maximal urinary flow, residual urine volume, postural hypotension, headaches and withdrawals due to adverse events.

See the addendum for more information.