RecommendationConsider offering cystoplasty to manage detrusor overactivity only to men whose symptoms have not responded to conservative management or drug treatment and who are willing and able to self-catheterise. Before offering cystoplasty, discuss serious complications (that is, bowel disturbance, metabolic acidosis, mucus production and/or mucus retention in the bladder, urinary tract infection and urinary retention).
Relative values of different outcomesSymptom score, relief of incontinence, quality of life and serious adverse events (death, sepsis, retention, UTI, bowel dysfunction, mucus, metabolic problems small malignant risk) were considered primary outcomes.
Trade off between clinical benefits and harmsCystoplasty is a major operation. Informed consent is essential. There is a high risk of both perioperative and long term complications. Whilst the primary problem of urgency incontinence may be relieved successfully, there is often a trade off with the development of new symptoms such as poor bladder emptying, recurrent infections and mucus production.
Economic considerationsThis intervention is associated with high costs and should be offered only if other treatments have failed.
Quality of evidenceNo clinical or economic evidence was identified.
Other considerationsSurgery of this magnitude requires clearly informed consent. It is essential that the patient understands the potential for development of serious complications and the significant change in quality of life that may occur.

From: 9, Surgery for men with storage symptoms

Cover of The Management of Lower Urinary Tract Symptoms in Men
The Management of Lower Urinary Tract Symptoms in Men [Internet].
NICE Clinical Guidelines, No. 97.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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