Additional Scenarios

Additional scenarios to exemplify the wide range of men eligible for the study

  • A man referred by GP because he has bothersome voiding LUTS despite an alpha blocker; he would be eligible 

  • A man referred by GP because he has bothersome voiding LUTS, but he has not yet tried analpha blocker; he would be eligible a) He could be given alpha blocker for a month, and be followed up in Research Clinic; he could then be offered UPSTEAM if still reporting bothersome LUTS 

  • A man referred by GP because he has bothersome voiding and storage LUTS despite drug treatment (e.g. alpha blocker or antimuscarinic); he would be eligible 

  • A man referred by GP because he has bothersome voiding and storage LUTS and who has not yet tried drugs (e.g. alpha blocker or antimuscarinic); he would be eligible (after onemonth of drug treatment (see 2a))

  • It may be a little late if the man is already on the waiting list for TURP (these men are not “considering TURP”, they have already decided on it), however some sites have found this to be a viable option that has been welcomed by patients. This requires carefully consenting and may not be appropriate for those who have been on the list for some time, but could be considered by sites 

Additional points to clarify
 

  • A man referred by GP because he has bothersome storage LUTS only (regardless of treatment); he may be eligible if direct questioning in Urology Clinic shows that he also has voiding problems. Otherwise he is not eligible, as most surgeons would not offer TURP.

  • A man with LUTS where the doctor seeing him initially strongly favours urodynamics; he should not be considered for UPSTREAM, therefore is not eligible.

  • A man with LUTS where the doctor seeing him initially slightly favours, or is uncertain about, urodynamics; he would be eligible. The man should, where possible, receive UPSTREAM assessments according to their randomised allocation. If you are uncertain how to proceed, you are welcome to contact the UPSTREAM office.

  • A man with LUTS where the doctor is considering 5-alpha reductase inhibitor treatment (e.g. finasteride); he is eligible. The prescription can be the conclusion of the surgical decision-making appointment. 

  • A man using intermittent catheterisation to prevent recurrence of a stricture; he may be eligible. Intermittent catheterisation as the main means of bladder emptying; not eligible.