Management of lower urinary tract symptoms in men: summary of NICE guidance

doi:10.1136/bmj.c2354

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Clare Jones, senior research fellow and project manager1,
Jennifer Hill, guidelines operations director1,
Christopher Chapple, chair of the guideline development group1, consultant urological surgeon 2
on behalf of the Guideline Development Group

¹National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians, London NW1 4LE
²Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF

Correspondence to: C Chapple c.r.chapple{at}sheffield.ac.uk

Lower urinary tract symptoms (LUTS) in men are related to problems with storage and voiding of urine and can occur after micturition. The many causes of LUTS include abnormalities or abnormal function of the bladder, prostate, urethra, or sphincters. The prevalence of LUTS increases as men get older, with about 30% of men aged 65 years and older having troublesome symptoms,1 which may require treatment. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on LUTS.2

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Lower urinary tract symptoms have been categorised according to the three stages of the bladder cycle3: storage (when filling of the bladder occurs), voiding (when the bladder actively expels its contents), and post micturition (immediately after voiding, while returning to the storage stage) (box).

Categories of lower urinary tract symptoms³

Storage (also symptoms of overactive bladder)

Urgency
Increased daytime frequency
Nocturia
Urinary incontinence

Voiding

Hesitancy
Straining
Slow stream
Splitting or spraying
Intermittency
Terminal dribble

Post-micturition

Post-micturition dribble
Feeling of incomplete emptying

Initial assessment

At initial assessment (in any setting and by a healthcare professional without specific training in managing LUTS in men) take the following actions.

Offer the patient an assessment of his general medical history to identify possible causes of LUTS and associated comorbidities; review current medication, including herbal and over the counter medicines (for example, Serenoa repens (saw palmetto) and pumpkin seed extract), to identify drugs that may be contributing to the problem. [Based on the experience and opinion of the Guideline Development Group (GDG)]
Offer a physical examination guided by urological symptoms and …