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Lower urinary tract symptoms in men, age-related (including symptoms of benign prostatic hyperplasia/hypertrophy) - Management
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How do I assess the severity and impact of stress urinary incontinence?
- Assess the severity of stress incontinence and its impact on quality-of-life by asking the man:
- How often do you need to pass urine?
- How often do you leak urine?
- What protection do you need to cope with the leakage?
- When do accidents happen?
- What drugs and herbal remedies are you taking?
- Do you manage your diet and fluid intake to try to control the leakage?
- Do you have pain or discomfort when passing urine?
Basis for recommendation
How do I manage stress urinary incontinence?
- If necessary, offer a choice of temporary urine containment products (such as sheath and leg bag, absorbent pads, and absorbent pants) to achieve social continence, and refer the man to the local continence service.
- To find the local continence service, telephone the Bowel and Bladder Foundation on 01536 533 255.
- Advise the man on fluid intake and lifestyle and offer information on self-help resources.
- When stress urinary incontinence is not caused by prostatectomy, refer the man for specialist assessment to confirm the cause.
- When stress urinary incontinence is caused by prostatectomy, offer referral for supervised pelvic floor muscle training.
- Advise that the exercises should be performed for at least 3 months before considering referral to secondary care for assessment for other invasive treatment options.
- Supervised pelvic floor training may be available from the local continence nurse, continence physiotherapist, or urology clinic.
Secondary care options for treating stress incontinence
- Options available in secondary care for treating stress incontinence include:
- External collecting devices such as sheath appliances and pubic pressure urinals.
- Indwelling catheterization.
- Surgical placement of a urethral artificial sphincter.
- Urinary diversion as a last resort, when all other treatments have failed.
- Treatments that may be available as part of a clinical trial include intramural injectables, implanted adjustable compression devices, and suburethral synthetic sling.
Basis for recommendation
These recommendations are in line with the guideline The management of lower urinary tract symptoms in men from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2010].
Providing information on stress urinary incontinence and self-help resources
- The recommendation to provide information is based on expert opinion [NICE, 2010].
Referral for stress urinary incontinence not caused by prostatectomy
- The recommendation to provide information is based on expert opinion [NICE, 2010].
Use of urine containment products
- The recommendations about offering urinary containment products are based on expert opinion [NICE, 2010].
Pelvic floor muscle training
- NICE found 11 relevant randomized controlled trials of pelvic floor muscle training [NICE, 2010]. The data may be unreliable because the studies had limitations in design and precision (size of study), and the results lacked consistency and directness of applicability. Nevertheless, NICE found evidence that pelvic floor muscle training for stress incontinence after prostatectomy:
- Did not reduce incontinence rates in the first 3 months after prostatectomy.
- Reduced incontinence rates between 4–12 months after prostatectomy.
Treatments not recommended
- Penile clamps are not recommended for men with urinary incontinence. This is based on the expert opinion of the NICE guideline development group [NICE, 2010].
- Electrical stimulation is not recommended because NICE found no reliable evidence that it is effective [NICE, 2010].
Secondary care treatments
- The information on treatments recommended as options in secondary care is from the NICE guidelines on lower urinary tract symptoms, where the evidence is reviewed [NICE, 2010].
What advice should I provide about self-help resources?
- Advise the man that:
- NHS Choices provides online information for people with urinary incontinence.
- The Bladder and Bowel Foundation has a helpline (telephone 01536 533 255), and provides a range of resources on their website www.bladderandbowelfoundation.org. Information on pelvic floor muscle training is included in their booklet on stress urinary incontinence, which can be ordered from their online shop or downloaded for printing (pdf).
- No drug is effective for stress incontinence in men. Some information leaflets cite the use of duloxetine for stress incontinence; however, this is for women only.
Basis for recommendation
These recommendations are in line with the guideline The management of lower urinary tract symptoms in men from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2010].
- NICE's recommendation to provide information and advice was made on the basis of expert opinion, as no relevant clinical trials were found [NICE, 2010].
What self-care advice should I provide about fluid intake and lifestyle for men with lower urinary tract symptoms?
- Fluid intake should be within the man's usual range, and should not be limited excessively in an attempt to control symptoms — doing this could increase the risk of complications such as urinary tract infection.
- Lifestyle advice may include:
- Avoiding constipation, or treating it (if it is present).
- Maintaining a healthy lifestyle (with respect to body weight, exercise, diet, smoking, and alcohol consumption).
- Limiting intake of tea, coffee, chocolate, artificial sweeteners, and fizzy drinks.
Basis for recommendation
These recommendations are in line with the guideline The management of lower urinary tract symptoms in men from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2010].
- NICE based these recommendations on expert opinion as they found no relevant clinical trials [NICE, 2010].
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