Table 5.

Summary of recommendations for LUTS post treatment for pelvic cancers

Summary of recommendations
Assessment General assessment including self‐reported incontinence Self‐reported continence can be complemented with validated questionnaires, e.g. IPSS and Qol questionnaires (e.g. ICIQ) Dipstick urinalysis for leucocytes and nitrites to rule out infection 7 day bladder diary (also recommended by NICE) Pad usage
PFMT recommendation Start PFMT pre‐treatment (ideally 1 month before surgery in case of RP) or within one month of RT/ADT treatment/catheter removal after surgery Physiotherapist assisted programme has the greatest benefit. Consider using a physiotherapist or at least a DVD with a physiotherapist demonstrating the exercises Continue on PFMT for at least 6 weeks Can be provided in combination with biofeedback, if possible
Oral treatment recommendation The sequencing is generally bound by local prescribing guidance. Current guidelines recommend that alpha blockers be given first, followed by antimuscarinics. However, our recommendation is to tailor the treatment based on the patient's needs, i.e. first line treatment should depend on what is the most bothersome symptom of LUTS. o  An alpha blocker (commonly tamsulosin) to be used first after radiotherapy if urge with leak incontinence though they are not recommended post‐surgery. Stricture should be excluded prior to starting alpha blockers o  Mixed storage & voiding symptoms: alpha blocker + antimuscarinic (usually tolterodine) recommended o  LUTS and erectile dysfunction: alpha blocker + PDE5‐I recommended o  Antimuscarinic (usually tolterodine) to be used first post‐surgery if urgency UI o  Antimuscarinic (Mirabegron if unacceptable adverse effects) +PDE5‐I if post‐surgery LUTS + ED We recommend reviewing every 3 months with each treatment; however, patients should be able to see the healthcare provider sooner if they experience adverse events
Other options (also included in existing guidelines) Patient education and health promotion: Advise on bladder retraining, fluid intake and dietary irritants, review existing medications. Caffeinated drinks: Ensure patients avoid caffeinated drinks, which can aggravate irritative storage symptoms. Containment devices
Duration If symptoms do not improve within at least 3 month of each intervention (or a combination of these) described here, referral may be warranted to specialist urology centres. NICE UI guidance has suggested a review either face to face or at least telephone at 4 weeks after initiating Antimuscarinics therapy. Therefore a 4 week telephone review can precede face to face 3 month review. We recommend that all management options should be used for as long as needed by the patient
Referral Referral should be considered if: Symptoms of LUTS persist after ≥ 3 month of conservative treatment or drug treatment Moderate to high (> 8) IPSS that fails to improve in spite of interventions IPSS showing high impact on QoL Frequency persists at > 8 times per day