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RecommendationInform men with LUTS and proven bladder outlet obstruction that bladder training is less effective than surgery.
Relative values of different outcomesSymptom score, quality of life (IPSS question) and maximum urinary flow rate were considered the primary outcomes.
Trade off between clinical benefits and harmsBladder training is less effective than surgical intervention in improving quality of life, symptom score and urinary flow rate. However, TURP is an invasive procedure and maybe have important complications such as blood loss and strictures.
Economic considerationsBladder training is more cost-effective than surgery in the short term. However being less effective, it may only delay the surgical intervention.
Quality of evidenceOnly two very small RCTs which compared bladder training against TURP were found.

The economic evidence has serious limitations and direct applicability.
Other considerationsPatient preference is an important consideration in deciding the appropriate treatment.

Some patients (e.g. those with cognitive problems) may not be able to perform bladder training.

From: 11, Conservative management versus surgery

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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