Lower urinary tract symptoms: The management of lower urinary tract symptoms in men
This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg97
4 Research recommendations
- 4.1 Multichannel cystometry
- 4.2 Catheterisation
- 4.3 Products for men with urinary incontinence
- 4.4 Laser vaporisation techniques
- 4.5 Male slings
The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline (see section 5).
4.1 Multichannel cystometry
What is the clinical and cost effectiveness of multichannel cystometry in improving patient-related outcomes in men considering bladder outlet surgery?
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.
4.2 Catheterisation
What are the clinical and cost effectiveness and associated adverse events of intermittent catheterisation compared with indwelling catheterisation (suprapubic or urethral) for men with voiding difficulty and chronic retention of urine?
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).
4.3 Products for men with urinary incontinence
What are the clinical and cost effectiveness and associated adverse events of absorbent pads compared with sheath collectors for men with urinary incontinence?
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/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.
4.4 Laser vaporisation techniques
What is the clinical and cost effectiveness of laser vaporisation techniques compared with TURP in men with moderate to severe bothersome LUTS considering surgery for bladder outlet obstruction?
Why this is important
The evidence base is inadequate to give clear guidance. This research would help plan future guidance on the use of laser vaporisation techniques for men with LUTS who are having surgery. The potential advantages of reduced blood loss, shorter hospital stay and earlier return to normal activities make laser vaporisation techniques attractive to both patients and healthcare providers, although there is uncertainty about the degree of symptom improvement and improvement in quality of life in the short and longer term. The study should be a randomised controlled trial.
4.5 Male slings
In men with mild to moderate post prostatectomy urinary incontinence, what is the clinical and cost effectiveness of a male sling or an implanted adjustable compression device, when assessed by 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.