Research interests

My research interests include benign and malignant prostate disease
Research appointment

Clinical Effectiveness Unit, Royal College of Surgeons of England / Institute of Urology, University College Hospital (2000 - 2004)

Self-Management for men with uncomplicated Lower Urinary Tract Symptoms: Evaluation of a complex intervention supervisors Professor Mark Emberton, Professor Jan van der Meulen, Professor Tony Mundy
Research findings published in the British Medical Journal (BMJ. 2007; 334 (7583): 25)
BUPA Foundation grant £145,000
Royal College of Surgeons Research Fellowship £40,000

MD Thesis (Abstract)

LUTS are a common chronic problem in the aging male. The treatment has developed into a “cascade” that escalates from watchful waiting through medical treatment to surgery. The use of lifestyle and behavioural (self-management) interventions for symptom control is widespread, however, their effectiveness is unknown.

To define, assess acceptability, feasibility and effectiveness of self-management as an intervention for men with uncomplicated LUTS.

In accordance with recommendations on the evaluation of complex interventions from the Medical Research Council, the design phase utilised qualitative research methods including interview, survey and formal consensus methods; the acceptability and feasibility phase, a pilot study that informed the design of a large scale randomised controlled effectiveness trial comparing self-management and standard care to standard care alone.

140 men were included. 73 were randomised to participate in the self-management programme and 67 to standard care alone. The distributions of the patient demographics in the self-management group and the standard care group were broadly similar. Patients in the self-management group had less severe symptoms (IPSS reduction 5.7, 95% CI [3.7 to 7.7], p<0.001) and lower rates of treatment failure (32% reduction 95% CI [18% to 46%], p<0.001) than patients in the standard care group after 3 months. These differences were maintained at 12 months, (IPSS reduction 5.1, 95%CI [2.7 to 7.6], p<0.001) and 48% reduction in treatment failure rates 95% CI [32% to 64%], p<0.001.

Self-management in addition to standard care significantly reduced the rate of treatment failure and improved urinary symptoms compared to standard care alone. Participation in a self-management programme is likely to result in men experiencing fewer symptoms, improved quality of life, and a reduction in the need for medical therapy. Because of the large benefit of self-management and the low risk of harm, self-management could be recommended as first-line treatment for men with LUTS.