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The management of lower urinary tract symptoms (LUTS) in men

The management of lower urinary tract symptoms (LUTS) in men. Implementing NICE guidance. 2 nd . Edition - November 2012. NICE clinical guideline 97. What this presentation covers. Background Scope Key priorities for implementation Other recommendations Costs and savings Discussion

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The management of lower urinary tract symptoms (LUTS) in men

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  1. The management of lower urinary tract symptoms (LUTS) in men Implementing NICE guidance 2nd. Edition - November 2012 NICE clinical guideline 97

  2. What this presentation covers • Background • Scope • Key priorities for implementation • Other recommendations • Costs and savings • Discussion • NHS Evidence and NICE Pathway • Find out more

  3. Background • Lower urinary tract symptoms (LUTS) comprise storage, voiding and post-micturition symptoms and have many possible causes. • They reduce quality of life and may point to serious pathology of the urogenital tract. • LUTS are a major burden for the ageing male population. • There is uncertainty and variation in clinical practice in the UK.

  4. Scope • This clinical guideline covers the management of men (18 and over) with LUTS. • Gives clear recommendations on diagnosing, monitoring and treating LUTS • Advises on the effective evidence-based management of LUTS in men.

  5. Key priorities areas for implementation • Initial assessment • Conservative management • Surgery for voiding symptoms • Providing information

  6. Initial assessment: 1 • Assess general medical history. Identify possible causes of LUTS based on past medical history and current medications. • Offer a physical examination guided by urological symptoms • Complete urinary frequency volume chart

  7. Initial assessment: 2 • At initial assessment do not routinely offer: • cystoscopy to men with uncomplicated LUTS • imaging of the upper urinary tract to men with uncomplicated LUTS • flow-rate measurement to men with LUTS • post void residual volume measurement to men with LUTS

  8. Initial assessment: 3 • 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

  9. Conservative management • Offer men with storage LUTS temporary containment products to achieve social continence until a diagnosis and management plan have been discussed • Offer men with storage LUTS suggestive of overactive bladder (OAB) supervised bladder training, advice on fluid intake, lifestyle advice and, if needed, containment products.

  10. Surgery for voiding symptoms  • If offering surgery for managing voiding LUTS presumed secondary to BPE: • DO: offer TURP, TUVP or HoLEP • DO NOT: offer TUNA, TUMT, HIFU, TEAP or laser coagulation as an alternative • Only consider offering laser vaporisation techniques, bipolar TUVP or monopolar or bipolar TURVP as part of a randomised clinical trial X !

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

  12. Other recommendations • Drug treatment • Managing retention • Surgery • Long-term catheterisation and containment

  13. Costs and savings per 100,000 population Costs correct at May 2010. Costs not updated for 2nd edition

  14. Discussion • How will this guideline affect our current practice? • What support do clinicians need to complete a thorough initial assessment for all patients? • How can the skills of nurses be used in managing men with LUTS? • How can the introduction of universal frequency volume chart at initial assessment in all patients with LUTS be achieved? • Who can supply or prescribe the temporary containment products recommended?

  15. NICE Pathway • The LUTS NICE pathway covers the management of lower urinary tract symptoms in men Click here to go to the NICE LUTS Pathway

  16. NHS Evidence Visit NHS Evidence for the best available evidence on all aspects of Lower Urinary Tract Symptoms in Men Click here to go to the NHS Evidence website

  17. Find out more • Visit www.nice.org.uk/CG97 for: • the guideline • the quick reference guide • ‘Understanding NICE guidance’ • costing report and template • commissioning guide • “over-the-counter” Tamsulosin information sheets • implementation advice • online educational tool • audit support statement and links to the national continence audit

  18. What do you think? • Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? • We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form. • If you are experiencing problems accessing or using this tool, please email implementation@nice.org.uk To open the links in this slide set right click over the link and choose ‘open link’

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