if a man has post micturition dribble then should be told how to perform urethral milking
if storage LUTS (particularly urinary incontinence) then should be offered temporary containment products (for example, pads or collecting devices) to achieve social continence until a diagnosis and management plan have been discussed
if storage LUTS suggestive of overactive bladder (OAB) then should be offered supervised bladder training, advice on fluid intake, lifestyle advice and, if needed, containment products
supervised pelvic floor muscle training should be offered to men with stress urinary incontinence caused by prostatectomy
continue the exercises for at least 3 months before considering other options
refer for specialist assessment men with stress urinary incontinence
external collecting devices (for example, sheath appliances, pubic pressure urinals) should be offered for managing storage LUTS (particularly urinary incontinence) in men before considering indwelling catheterisation
intermittent bladder catheterisation should be offered before indwelling urethral or suprapubic catheterisation to men with voiding LUTS that cannot be corrected by less invasive measures
long-term indwelling urethral catheterisation should be considered for men with LUTS:
for whom medical management has failed and surgery is not appropriate and
who are unable to manage intermittent self-catheterisation or
with skin wounds, pressure ulcers or irritation that are being contaminated by urine or
who are distressed by bed and clothing changes
consider permanent use of containment products for men with storage LUTS (particularly urinary incontinence) only after assessment and exclusion of other methods of management
Drug treatment
offer drug treatment only to men with bothersome LUTS when conservative management options have been unsuccessful or are not appropriate
offer an alpha blocker (alfuzosin, doxazosin, tamsulosin or terazosin) to men with moderate to severe LUTS, especially if voiding type (hesitancy, poor stream)
offer a 5-alpha reductase inhibitor to men with LUTS who have prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml, and who are considered to be at high risk of progression (for example, older men)
consider offering a combination of an alpha blocker and a 5-alpha reductase inhibitor to men with bothersome moderate to severe LUTS and prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml
consider offering an anticholinergic as well as an alpha blocker to men who still have storage symptoms after treatment with an alpha blocker alone
consider offering a late afternoon loop diuretic to men with nocturnal polyuria
consider offering oral desmopressin to men with nocturnal polyuria if other medical causes have been excluded and they have not benefited from other treatments. Measure serum sodium 3 days after the first dose. If serum sodium is reduced to below the normal range, stop desmopressin treatment.
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