Key priorities for implementation

The following recommendations were identified as priorities for implementation in the 2010 guideline and have not been changed in the 2015 update.

Initial assessment

  • At initial assessment, offer men with lower urinary tract symptoms (LUTS) an assessment of their general medical history to identify possible causes of LUTS, and associated comorbidities. Review current medication, including herbal and over-the-counter medicines, to identify drugs that may be contributing to the problem. [2010]

  • At initial assessment, offer men with LUTS a physical examination guided by urological symptoms and other medical conditions, an examination of the abdomen and external genitalia, and a digital rectal examination. [2010]

  • At initial assessment, ask men with bothersome LUTS to complete a urinary frequency volume chart. [2010]

  • Refer men for specialist assessment if they have LUTS complicated by recurrent or persistent urinary tract infection, retention, renal impairment that is suspected to be caused by lower urinary tract dysfunction, or suspected urological cancer. [2010]

Conservative management

  • Offer men with storage LUTS (particularly urinary incontinence) temporary containment products (for example, pads or collecting devices) to achieve social continence until a diagnosis and management plan have been discussed. [2010]

  • Offer men with storage LUTS suggestive of overactive bladder supervised bladder training, advice on fluid intake, lifestyle advice and, if needed, containment products. [2010]

Surgery for voiding symptoms

  • If offering surgery for managing voiding LUTS presumed secondary to benign prostate enlargement (BPE), offer monopolar or bipolar transurethral resection of the prostate (TURP), monopolar transurethral vaporisation of the prostate (TUVP) or holmium laser enucleation of the prostate (HoLEP). Perform HoLEP at a centre specialising in the technique, or with mentorship arrangements in place. [2010]

  • If offering surgery for managing voiding LUTS presumed secondary to BPE, do not offer minimally invasive treatments (including transurethral needle ablation [TUNA], transurethral microwave thermotherapy [TUMT], high-intensity focused ultrasound [HIFU], transurethral ethanol ablation of the prostate [TEAP] and laser coagulation) as an alternative to TURP, TUVP or HoLEP (see recommendation¬†1.5.2). [2010]

Providing information

  • Make sure men with LUTS have access to care that can help with:

    • their emotional and physical conditions and

    • relevant physical, emotional, psychological, sexual and social issues. [2010]

  • Provide men with storage LUTS (particularly incontinence) containment products at point of need, and advice about relevant support groups. [2010]

  • National Institute for Health and Care Excellence (NICE)