Urinary problems in men: self-management advice is helpful

Why was the study needed?

Urinary problems, such as needing to pass urine more often, urgently, or during the night, and difficulties passing urine, might be caused by an enlarged prostate, impaired bladder function, or both. Problems become more common as men age: nearly one third of all men older than 65 years are affected. Symptoms can cause distress, disrupt sleep, or, for example, mean that trips have to be planned around available toilets.

National Institute for Health and Care Excellence guidelines recommend offering advice to men with urinary problems (pelvic floor exercises and lifestyle changes, for instance) before trying tablets or surgery. It is not known how helpful this advice is.

What did the study do?

The researchers invited 1077 men who had presented to primary care with lower urinary tract symptoms in the past five years from 30 GP surgeries in England. Half were randomly allocated to receive self-management advice and were directed to relevant sections of a patient booklet developed by the researchers. They were also contacted by clinicians (nurses and healthcare assistants) three times over 12 weeks to encourage them to follow the advice. The others received usual care, which varied but could include advice, medication, referral to a consultant, or continuing to live with symptoms.

What did it find?

The main outcome of the study, based on 424 men in the advice group and 463 in the usual care group, was improvement in urinary problems at 12 months measured using the validated patient reported International Prostate Symptom Score. The researchers sought to detect a difference of 2.0 points rather than the minimum clinically important difference of 3.0 points, recognising that men might be bothered by just one symptom (eg, nocturia). Compared with usual care, those who received self-management advice:

• Had a greater improvement in their symptoms; the overall improvement was slightly less than is considered meaningful (adjusted mean difference in the intervention group of −1.81 points, 95% confidence interval −2.66 to −0.95 points)

• Reported slightly better quality of life and felt better about their urinary problems.

There was no difference between groups in the likelihood of a urology referral or an adverse event, and costs to the NHS per patient were similar in both groups.

The researchers also conducted qualitative interviews with 58 men with urinary problems who participated in the study. Many had been unaware of self-management techniques for urinary problems before they took part. Those receiving the booklet generally welcomed the advice, and said it improved their symptoms and their understanding of their urinary problems. They appreciated their problems being taken seriously and not dismissed as a normal part of getting older. By contrast, men in the usual care group were often resigned to their symptoms and felt that they would not change. Some said that opportunities for detailed self-management advice had been missed in GP consultations.

Why is this important?

The self-management advice provided a small, sustained benefit in men’s urinary problems and offered value for money. Men appreciated the advice and the control it offered over their symptoms.

Although improvement in symptoms did not reach the study’s target, researchers say that the advice is still beneficial because the improvement was sustained one year after initial contact and many men did report a meaningful improvement and improved quality of life. The lack of awareness of self-management for urinary problems among men reinforces the importance of the advice, they say.

Almost all (98%) men in the study were white; further work is required to show that the findings apply to people of other ethnicities.

What next?

The researchers suggest that more men could be given the self-management advice booklet at a relatively low cost. In addition, nurses and healthcare assistants need minimal training to advise men with urinary problems using the resources provided by the trial.

The researchers are working with their local primary care services to develop a guide for primary care clinicians on assessing urinary problems, including helping patients keep a bladder diary. The guide will appear as a prompt on their computer when they begin these consultations. In addition, an adapted version of the booklet developed for this study is being used in another study supporting the health of older people in Zimbabwe.