RecommendationConsider offering intermittent self- or carer-administered catheterisation instead of surgery in men with chronic retention who you suspect have markedly impaired bladder function.
Relative values of different outcomesChange in symptom scoring was the only outcome reported but QOL would be more helpful as IPSS score is not a useful measure in men self catheterising. In chronic retention patients there is often little in the way of LUTS and hence undue reliance on scoring of LUTS may be misleading.
Trade off between clinical benefits and harmsThe GDG considered the avoidance of surgery and surgical morbidity versus the benefit of a definitive solution and the inconvenience and discomfort of self- catheterisation over a potentially long period. Ultimately this will depend on an assessment of whether the bladder has sufficient function to result in adequate bladder emptying after surgical intervention. Discussion between the patient and clinician should take account of mode of presentation -high (associated renal failure) or low pressure chronic retention and evidence from assessment of post void residuals/catheterisation volumes and urodynamic assessment with pressure flow studies.
Economic considerationsIn men with poor bladder function TURP might fail to solve the problem, generating unnecessary costs.
Quality of evidenceThere was only one small study found in patients with chronic retention; the level of uncertainty with the evidence is very high.

No economic studies were identified.
Other considerationsPatient preference, fitness for surgery and the likelihood of success following a surgical intervention vs. continued catheterisation are factors in helping men to decide on the relative benefits of each option.

From: 13, Treating men with urinary retention

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).
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