Management of Non-neurogenic Male LUTS

6. FOLLOW UP

6.1. Watchful waiting (behavioural)

Patients who elect to pursue a WW policy should be reviewed at six months and then annually, provided there is no deterioration of symptoms or development of absolute indications for surgical treatment. The following are recommended at follow-up visits: history, IPSS, uroflowmetry, and PVR volume.

6.2. Medical treatment

Patients receiving α1-blockers, muscarinic receptor antagonists, beta-3 agonists, PDE5Is or the combination of α1-blockers and 5-ARIs or muscarinic receptor antagonists should be reviewed four to six weeks after drug initiation to determine the treatment response. If patients gain symptomatic relief in the absence of troublesome adverse events, drug therapy may be continued. Patients should be reviewed at six months and then annually, provided there is no deterioration of symptoms or development of absolute indications for surgical treatment. The following are recommended at follow-up visits: history, IPSS, uroflowmetry, and PVR volume. Frequency volume charts or bladder diaries should be used to assess response to treatment for predominant storage symptoms or nocturnal polyuria.

Patients receiving 5-ARIs should be reviewed after twelve weeks and six months to determine their response and adverse events. The following are recommended at follow-up visits: history, IPSS, uroflowmetry and PVR volume. Men taking 5-ARIs should be followed up regularly using serial PSA testing if life expectancy is greater than ten years and if a diagnosis of PCa could alter management. A new baseline PSA should be determined at six months, and any confirmed increase in PSA while on 5-ARIs should be evaluated.

In patients receiving desmopressin, serum sodium concentration should be measured at day three and seven, one month after initiating therapy and periodically during treatment. If serum sodium concentration has remained normal during periodic screening follow-up screening can be carried out every three months subsequently. However, serum sodium concentration should be monitored more frequently in patients > 65 years of age and in patients at increased risk of hyponatremia. The following tests are recommended at follow-up visits: serum-sodium concentration and FVC. The follow-up sequence should be restarted after dose escalation.

6.3. Surgical treatment

After prostate surgery, patients should be reviewed four to six weeks after catheter removal to evaluate treatment response and adverse events. If patients have symptomatic relief and are without adverse events, no further re-assessment is necessary. The following tests are recommended at follow-up visit after four to six weeks: IPSS, uroflowmetry and PVR volume.