Between 2014 and 2018 we conducted a multicentre randomised controlled trial (study) (“UPSTREAM – Phase I”) in 26 hospitals across England.  To recap; when referred to hospital, men with bothersome lower urinary tract symptoms (LUTS) are assessed with a set of standard assessments (tests). UPSTREAM set out to see whether including an extra assessment called “urodynamics” helps when considering treatment options. 

Men who took part (n=820) were split into two groups to receive either standard assessments (routine care) or routine care plus urodynamics. All men then discussed the results of the tests with their urologist and decided what treatment to have. 18-months after men agreed to take part in the study, they completed a questionnaire booklet about their urinary symptoms, the effect on their everyday life, and their general state of health, and identified what treatment they received. The study aimed to provide evidence to help doctors and the National Health Service (NHS) decide whether urodynamics should be more widely used for the assessment of men with LUTS who are seeking further treatment, such as surgery.

During the first phase of the UPSTREAM study, however, we identified that there is significant variation in the assessment pathway in 26 hospitals across England, including duration, as well as in patient factors. We identified that several patients had not fully completed their LUTS treatment when they reached the 18-month follow up, or had completed it less than 6-months beforehand. From a clinical perspective, a 12-month timeframe is appropriate to show the immediate impact of surgery. Additionally, very little is known about men’s attitudes to the long-term experience of LUTS and associated treatments, which has been identified as a research priority.

Hence “UPSTREAM – Phase II”, the further (long term) follow up of UPSTREAM participants, five years post-randomisation. (Please see separate section, below, for more details).

In 2018, based on the reasons noted above, the NIHR HTA awarded a funding extension to conduct further (long term) follow up of UPSTREAM participants, five years post-randomisation.

In this further follow up study (“UPSTREAM – Phase II”), we wanted to find out the longer term (5-year) results of treatment for the men’s LUTS, and see how many men went on to receive surgery after the initial 18-months (i.e. after the original study, “UPSTREAM - Phase I”).

In taking part in “UPSTREAM - Phase II”, men did not need to return to hospital for any clinical assessments. Instead we asked them to complete one questionnaire booklet about their urinary symptoms, the effect on their everyday life, and their general state of health. To thank men for their time, we offered them a £20.00 gift voucher upon receipt of the completed questionnaire. We also securely collected information relevant to this study from central NHS records (such as information about relevant inpatient stays and outpatient attendances).

The further follow up phase formally started on 01 July 2019 and completed in December 2023. The data has been analysed and a results paper is pending publication.

You can read a summary of the results here: UPSTREAM Phase II Summary of the Results (PDF, 93kB)

• “UPSTREAM – Phase I” (complete)
• “UPSTREAM – Phase II” (complete)

If you would like to get in touch, you can contact the Study Office using the details below. Further information about the Study Team are also available here.

Dr Amanda Lewis (Trial Manager) | Tom Steuart-Feilding (Trial Administrator)

Tel: 0117 331 3907 or 0117 928 7276

Email: upstream-trial@bristol.ac.uk