Evidence

2019 surveillance of lower urinary tract symptoms in men: management (NICE guideline CG97)

Overview of 2019 surveillance methods

Overview of 2019 surveillance methods

NICE's surveillance team checked whether recommendations in lower urinary tract symptoms in men (NICE guideline CG97) remain up to date.

The surveillance process consisted of:

  • Feedback from topic experts via a questionnaire.

  • A search for new or updated Cochrane reviews and national policy.

  • Consideration of evidence from previous surveillance.

  • Examining related NICE guidance and quality standards and NIHR signals.

  • A search for ongoing research.

  • Examining the NICE event tracker for relevant ongoing and published events.

  • Literature searches to identify relevant evidence.

  • Assessing the new evidence against current recommendations to determine whether or not to update sections of the guideline, or the whole guideline.

  • Consulting on the proposal with stakeholders.

  • Considering comments received during consultation and making any necessary changes to the proposal.

For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Evidence considered in surveillance

Search and selection strategy

We searched for new evidence related to the whole guideline.

We found 166 studies in a search for randomised controlled trials and systematic reviews published between 15 November 2013 and 31 March 2019.

We also included:

  • 1 relevant study from a total of 11 studies identified by topic experts which was also identified through our search.

  • 222 studies identified by search in previous surveillance in 2012 and 2014.

From all sources, we considered 388 studies to be relevant to the guideline.

See appendix A for details of all evidence considered, and references.

Ongoing research

We checked for relevant ongoing research; of the ongoing studies identified, 6 studies were assessed as having the potential to change recommendations. Therefore, we plan to check the publication status regularly and evaluate the impact of the results on current recommendations as quickly as possible. These studies are:

Intelligence gathered during surveillance

Views of topic experts

We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.

We sent questionnaires to 7 topic experts and received 3 responses.

Key points highlighted in topic expert feedback included:

  • The guideline should address new treatment modalities including UroLift, Rezum, laser vaporisation of the prostate and prostate artery embolisation. These interventions should also be included in the NICE Pathway on lower urinary tract symptoms.

  • HoLEP (Holmium Laser Enucleation of the Prostate) may be a superior treatment compared with TURP (Transurethral Resection of the Prostate).

  • HoLEP may be a superior treatment compared with open prostatectomy for prostates of any size.

  • The guideline should evaluate the potential risk of cognitive decline with antimuscarinic drugs.

  • The guideline should evaluate combination therapy with solifenacin and mirabegron.

Other sources of information

We considered all other correspondence received since the guideline was published.

Views of stakeholders

Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because the initial surveillance proposal was to not update the guideline, we consulted with stakeholders.

Overall, 6 stakeholders commented including representatives from royal colleges (Physicians and Surgeons of Glasgow, Nursing), British Association of Urological Surgeons (BAUS), Bladder and Bowel UK, and pharmaceutical companies (Ferring Pharmaceuticals, GlaxoSmithKline). One stakeholder agreed and 5 disagreed with the proposal to not update the guideline.

Stakeholders raised several concerns with the existing guideline. They considered that the current guideline is incomplete and outdated and does not reflect current clinical practice, with a range of new interventions for the treatment and management of lower urinary tract symptoms, particularly surgical interventions, having been introduced since the guideline was developed in 2010. These include significant advances in technology and introduction of new procedures such as UroLift, Rezum, Aquablation and PAE (Prostate Artery Embolisation).

See appendix B for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

Equalities

No equalities issues were identified during the surveillance process.

Editorial amendments

During surveillance we identified the following issues with the NICE guideline that should be corrected:

Overall decision

After considering all evidence and other intelligence and the impact on current recommendations, we decided that the guideline should be updated.

NICE's interventional procedures team and medical technologies evaluation programme team were consulted on the proposal and agreed that the guideline should be updated, because of advances in surgical procedures over the last few years.

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