This quality standard covers the diagnosis and management of lower urinary tract symptoms (LUTS) in men (18 years and older). For more information see the scope.
LUTS are storage, voiding and post-micturition symptoms that affect the lower urinary tract. These 3 types of symptom are used to help define the source of the problem. Storage symptoms include frequency, nocturia, urgency and urgency incontinence. Voiding symptoms include weak stream, intermittent urinary stream, straining to void, hesitancy and terminal dribbling. The most common post-micturition symptoms are the feeling of incomplete emptying and post-micturition dribbling, which is a common and bothersome symptom. Although LUTS do not usually cause severe illness, they can considerably reduce a man's quality of life, and may indicate serious underlying pathology of the urogenital tract.
Age is an important risk factor for LUTS and the prevalence increases as men get older. Bothersome LUTS can occur in up to 30% of men over 65 years. This is a large group potentially needing treatment.
NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health:
Table 1 shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:
Table 1 NHS Outcomes Framework 2013/14
Overarching indicators and improvement areas
2 Enhancing quality of life for people with long-term conditions
2 Health-related quality of life for people with long-term conditions
Ensuring people feel supported to manage their condition
2.1 Proportion of people feeling supported to manage their condition
Improving functional ability in people with long-term conditions
2.2 Employment of people with long-term conditions
Enhancing quality of life for carers
2.4 Health-related quality of life for carers
4 Ensuring that people have a positive experience of care
4a Patient experience of primary care
i GP services
ii GP out of hours services
4b Patient experience of hospital care
Improving people's experience of outpatient care
4.1 Patient experience of outpatient services
Improving hospitals' responsiveness to personal needs
4.2 Responsiveness to inpatients' personal needs
Improving people's experience of accident and emergency services
4.4 Access to i GP services
The quality standard for LUTS specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole LUTS care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to men with LUTS.
The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for men with LUTS are listed in Related quality standards.
The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating LUTS in men should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.
Community and hospital pharmacists also offer advice and education for men with LUTS and can also direct men to other sources of help and support. Pharmacists offering this service should have training and mentoring for this role.
Quality standards recognise the important role families and carers have in supporting men with LUTS. If appropriate, healthcare professionals and social care and public health practitioners should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.