Surgical treatment for storage symptoms (e.g. nocturia, frequency, urgency) in men

Storage symptoms include urgency, frequency, urgency incontinence and nocturia

Surgery for storage symptoms has been outlined by NICE with respect to men with lower urinary tract symptoms (LUTS):

• if offering surgery for storage symptoms, consider offering only to men whose storage symptoms have not responded to conservative management and drug treatment. Discuss the alternatives of containment or surgery
• consider 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)
• consider offering bladder wall injection with botulinum toxin to men with detrusor overactivity only if their symptoms have not responded to conservative management and drug treatments and the man is willing and able to self-catheterise
• consider offering implanted sacral nerve stimulation to manage detrusor overactivity only to men whose symptoms have not responded to conservative management and drug treatments
• do not offer myectomy to men to manage detrusor overactivity
• consider offering urinary diversion to manage intractable urinary tract symptoms only to men whose symptoms have not responded to conservative management and drug treatments, and if cystoplasty or sacral nerve stimulation are not clinically appropriate or are unacceptable to the patient
• consider offering implantation of an artificial sphincter to manage stress urinary incontinence only to men whose symptoms have not responded to conservative management and drug treatments

Reference:

• 1) NICE (June 2015). Lower urinary tract symptoms The management of lower urinary tract symptoms in men