National Institute for Health and Clinical Excellence (NICE)
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Tackling 'waterworks' problems among men over 50

Millions of men with urine problems will now have access to better treatments on the NHS, thanks to new guidance published by NICE.

Around 1 in 4 men aged 40 and above have lower urinary tract symptoms (LUTS), such as needing to urinate urgently or frequently, retention of urine, hesitancy and incontinence. The symptoms can have a considerable impact on a man’s physical, mental and social wellbeing. They can also be caused by an underlying health concern, such as a urinary tract infection or prostate cancer.

There was previously no national guidance for diagnosing and treating these symptoms in adult men, which meant that healthcare professionals were not always using the most effective treatments. The new guideline from the National Institute for Health and Clinical Excellence (NICE) aims to set a national standard so that all patients receive the same high quality treatments wherever they go.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said:

“Urinary problems are estimated to affect around a quarter of men over forty, but the actual figure could be much higher as many men may be too embarrassed to visit their GPs for help, or unaware that they can be treated.

“As the prevalence of these symptoms increases with age, and with life expectancy on the rise in Britain, it is vital that the NHS uses the treatments and management techniques that are proven to work best.

“This is the first time that we have published guidance specifically on how adult men with these symptoms should be diagnosed and treated. We hope that it will help standardise any variations in clinical practice and encourage more men to seek medical advice if they have any concerns.”

Among the recommendations, NICE advises that:

  • When the patient first visits his healthcare professional about his symptoms, he should be asked about his general medical history and given an examination of his abdomen and genitals. He should also be asked to record his symptoms in a “bladder diary” and offered a urine test and a digital rectal examination; if the prostate gland feels abnormal or enlarged, or if the patient is concerned about cancer, he should be referred for a prostate specific antigen testing (a blood test which measures protein levels).
  • If the patient’s symptoms are not complicated or bothersome, the healthcare professional should advise him about conservative management techniques, such as temporary containment products (e.g. pads or collecting devices), bladder training, and lifestyle interventions (e.g. moderating their caffeine intake).
  • Men should only be offered drug treatments if their symptoms are bothersome or if conservative management options have been unsuccessful or are inappropriate. Surgery should be considered if medication has been unsuccessful or is inappropriate.
  • Men with acute urine retention should be catheterised immediately. They should be offered an alpha blocker before the catheter is removed and should remain catheterised while surgical treatment is considered.
  • Healthcare professionals should not offer homeopathy, acupuncture, or herbal or plant based treatments for these symptoms as the evidence does not support their use. Herbal treatments may also cause side effects or interact with other drugs.

Roy, a 75 year old man who has experienced urine symptoms said:

“For over twenty years I experienced some dribbling after going to the toilet, which caused me great embarrassment if visible spots appeared on my trousers. Instead of going to see my doctor straightaway, I thought I could hide the problem by using makeshift pads, or by not drinking as much water, which only made me feel dehydrated and still very much concerned that there was something physically wrong with me.

“I am very encouraged by this new guideline from NICE, which will hopefully benefit many men in a similar position to mine or who have any symptoms of 'waterworks problems'. In particular I hope that it encourages younger men to come forward at an early stage as many may feel inhibited by the social taboos that surround these issues.”

Professor Christopher Chapple, Chair of the Guideline Development Group that produced the recommendations for NICE and a Consultant Urological Surgeon said:

“Lower urinary tract symptoms can be challenging to identify correctly because they are not specific to just one disease. What’s more, there is wide variation in how patients with these symptoms are currently treated; such as how their clinical histories are taken and interpreted, or which treatments should be offered and when.

“The symptoms can greatly interfere with a man’s quality of life and cause serious disruption, both at home and in the workplace. The need for a consistent approach across the NHS is highlighted in this guideline.”

Dr Julian Spinks, a GP and Guideline Developer said:

“There really is no need for men to feel reluctant about visiting their GP or other healthcare professional if they have any concerns about urine problems, or for them to suffer in silence.

“The symptoms can be treated in a variety of different ways depending on the patient’s medical requirements and choice, from self-help methods to medications or surgical procedures.

“I hope that this guideline will prove to be a useful resource for the NHS and the potentially large group of patients that may require treatment.”

'Understanding NICE guidance - LUTS

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