Primus

Primary care management of lower urinary tract symptoms in men: development and validation of a diagnostic and clinical decision support tool.

Background

Many men, as they get older, experience problems passing urine. They may need to pass urine more frequently than usual, find their sleep interrupted by having to go to the toilet during the night, notice a change in their flow rate when they urinate or may experience loss of bladder control. These problems are grouped into what we call Lower Urinary Tract Symptoms (LUTS). These symptoms can be unpleasant, can impact on work and social life, and may prompt a visit to a GP for treatment.

GPs follow certain processes when considering signs of serious conditions, but there is currently no single effective way to identify and treat the underlying cause of LUTS. This means that men are usually referred to hospital for specialist urology tests, and often have treatment that could have been given out by the GP, such as advice about lifestyle measures that may improve symptoms, or medication.

Decision aid for GPs

The aim of the PriMUS study is to create a clinical decision support tool to help GPs find out the most likely cause of patients’ urinary symptoms, so that together they can choose the best treatment. We believe that this will have many benefits such as getting the right treatment sooner, avoiding unnecessary hospital visits, and getting those who need to be seen by a specialist there more quickly.

The clinical decision support tool will be a computer programme, where the GP will enter patient information and test results. Most of these tests are already done by GPs when a man has urinary symptoms, including a digital rectal examination (where a gloved finger is inserted into the rectum to feel the prostate), symptoms questionnaire and, a PSA test (a blood test which may be helpful for patients with suspected prostate cancer). The programme will then display the most likely cause of symptoms and suggested treatment and management options.

Developing more accurate future tests

In order to create the clinical decision support tool, we need all men taking part to have a test called ‘urodynamics’, which is the most accurate test to determine the cause of urinary symptoms, and is normally only available to men once they are referred to a specialist by their GP. This is an invasive test where catheters are inserted into the bladder and rectum so that bladder pressure can be measured. We can then work out how the less invasive tests above relate to results from urodynamics, so that in the future only the less invasive tests are needed.

Recruitment

We are inviting 880 men across the UK to take part in the PriMUS study to develop a symptom guide, helping to more accurately identify the cause of the LUTS and guide effective treatment.