This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Men with urinary problems may need to pass urine more often, or have difficulties passing urine. Researchers developed a booklet of self-management advice, and found that, compared with usual care, giving the booklet led to:
- greater improvements in men's symptoms
- similar costs to the NHS.
The improvement in men’s symptoms was relatively small, but the researchers say that more men could benefit from self-management advice for urinary problems.
The issue: does self-management advice help men with urinary problems?
Urinary problems, such as needing to pass urine more often, urgently or during the night, and difficulties passing urine, may 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’s new?
The researchers invited 1,077 men with troublesome urinary problems 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) 3 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.
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. 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
- 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 adverse event.
Costs to the NHS per patient were similar in both groups.
The researchers also interviewed 58 men with urinary problems. 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.
The improvement in symptoms did not reach the study’s target; the overall change was slightly below the level considered meaningful. The researchers say that the advice is still beneficial because the improvement was sustained 1 year after initial contact; many men did have 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’s 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. At least one of the research sites is continuing to use the intervention. Better awareness of self-management for urinary problems could reduce the numbers referred for more serious interventions, such as surgery.
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.
You may be interested to read
This is a summary of: Worthington J, and others. Lower urinary tract symptoms in men: the TRIUMPH cluster RCT. Health Technology Assessment 2024; 28; 1 – 162.
Information on prostate problems from the NHS.
Information and support about urinary problems in men from Better Health.
Funding: NIHR Health Technology Assessment Commissioned Call.
Conflicts of Interest: Several authors have received fees and funding from pharmaceutical companies. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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