New treatment intervention for male urinary problems shown to reduce symptoms

A new intervention for men with urinary problems trialled across GP practices has shown a sustained reduction in symptoms. Findings from the University of Bristol-led Treating Urinary Symptoms in Men in Primary Healthcare (TRIUMPH) study, involving over 1,000 participants and 30 GP practices, have been published in the British Medical Journal (BMJ). The study was funded by the National Institute for Health and Care Research (NIHR).

The severity and prevalence of lower urinary tract symptoms [LUTS] in men increases with age (up to 30% in men over 65 years), with greater numbers likely to be affected as the population ages. Symptoms can have a substantial impact on quality of life but can also influenced by lifestyle factors.

Current therapies recommended by NICE (National Institute for Health and Care Excellence) include bladder training, controlling fluid intake and lifestyle advice. However, there is a lack of evidence on their effectiveness, and provision by GP practices varies.

Bristol Medical School researchers sought to trial whether a new intervention, comprising a healthcare professional consultation and an information booklet providing conservative and lifestyle guidance, could be more effective than usual care.

The team recruited 1,077 adult men, each suffering with troublesome urinary tract symptoms between June 2018 and August 2019.  Participants were split with 524 in the intervention arm and 553 in the usual care arm. Participants in the intervention arm were directed to relevant sections of the booklet by general practice nurses/healthcare assistants or research nurses following urinary symptom assessment, with subsequent contacts over 12 weeks to ask how the participant was managing.

Overall, the study’s findings showed a range of troublesome urinary tract symptoms improved over 12 months in a population of men with moderate symptom severity, using a standardised booklet and manualised approach to symptom management. Analyses of symptoms in each trial arm found the intervention achieved a greater reduction in symptoms than usual care, and that the difference was maintained in the longer term.

Consultant Urologist and Bladder and Bowel Confidence HIT co-director, Professor Marcus Drake, the study’s Chief Investigator, who carried out the study while Professor of Physiological Urology at the University of Bristol and Honorary Consultant Urologist at Southmead Hospital, said:

“The assessment of male lower urinary tract symptoms and use of conservative treatments in primary care are inconsistent. Until now, there was limited evidence that conservative treatments are effective, despite their recommendation in national guidelines. The TRIUMPH study aimed to address this need in primary care.

“Implementation of this intervention as management in primary care, has the potential to improve care and reduce drug prescriptions.  Our study also found the intervention can be delivered by practice nurses or healthcare assistants rather than GPs.”

Dr Jon Rees, GP Partner at Tyntesfield Medical Group, and Chair of the Primary Care Urology Society, added:

“In primary care we have often traditionally relied upon pharmaceutical management for men with bothersome urinary symptoms – the TRIUMPH study emphasises the importance of discussing conservative measures with all of these patients – for some men, this will be all that is required, for others these measures can act as an adjunct to any medication prescribed.

“Many men will prefer to avoid long-term medication, so an understanding of the potential benefits of the interventions used in the study is a vital part of the toolkit for any clinician managing these patients.”

The study was designed and delivered in collaboration with the Bristol Trials Centre, a UKCRC registered clinical trials unit. The trial was hosted by the NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (CCG).

Paper

‘Treating male lower urinary tract symptoms in primary healthcare using conservative interventions: the TRIUMPH cluster randomised controlled trial’ by Marcus J Drake, Jo Worthington, Jonathan Rees et al. in BMJ [open access]