TRIUMPH: TReating Urinary symptoms in Men in Primary Healthcare using non-pharmacological and non-surgical interventions


National Institute for Health (NIHR) Health Technology Assessment (HTA) Ref. 16/90/03

What is the research question?

Does personalised advice based on a nurse’s assessment of men’s urinary symptoms achieve improved symptom control compared with usual care?

What is the problem?

Lower Urinary Tract Symptoms (LUTS) refer to problems with storing urine, such as increased urinary day-time frequency, urgency and having to pass urine overnight. LUTS also include problems such as slow stream while passing urine, or dribbling afterwards. Half of men over 40 experience at least one LUTS, which can badly impair the lives of the sufferers and their partners. Most men are diagnosed and treated by their GP and usual care is typically general advice and offer of tablets, such as an “alpha-blocker” for the prostate. However, many factors may not be fully considered, including the potential to avoid tablets by addressing factors such as the patient’s caffeine intake. Detecting these and offering relevant advice is time-consuming, but potentially beneficial.

What is the aim of the research?

To evaluate whether tailored care based on nurse-led assessment of an individual’s LUTS yields better symptoms, and reduces demands on physicians, in primary and secondary care.

How will this be achieved?

TRIUMPH is a randomised controlled trial in men who have bothersome LUTS. It will compare “usual care” against “tailored care” Men in the “tailored care” group will be offered relevant non-drug therapy, based on an assessment by a trained nurse. The nurse will educate the patient on LUTS, teach him the appropriate treatment(s), and provide written information. Ongoing support will be offered to help men adhere to the treatments, which may include advice on drinks, pelvic muscle exercises, bladder training and techniques to reduce dribbling. GP practices in Bristol and Southampton will recruit men to the study, and each practice will provide only one type of LUTS treatment (either usual care, or the tailored care). This is because GPs might alter their usual care if some patients in their practice are receiving tailored care. Our main (primary) outcome is to find out if tailored treatment achieves better symptom relief overall than usual care, by comparing the change in something called the prostate symptom score (IPSS) between the two groups after a year. We will also compare quality of life, men’s belief in their ability to manage LUTS themselves, how many men are referred for extra treatment, adverse effects of the care, and cost-effectiveness. Qualitative interviews will be undertaken with a group of men in the study who are selected purposely to represent the population of men attending primary care with LUTS.

Who is leading the research?

Prof Marcus Drake, Professor of Urology, School of Clinical Sciences, University of Bristol.

Further information:

About this research

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The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.