Lower Urinary Tract
Symptoms (LUTS) in men
Kamal Patel GPST2
Objectives
• Define ‘LUTS’
• Causes of LUTS
• Initial assessment and management
• Not covered
– Mx of acute retention
– Stress incontinence
– Prostate Ca
•
A 79 year-old man complains of LUTS.
Which one of the following regarding
BPH is incorrect?
1. Goserelin is licensed for refractory cases
2. Side effects of 5α-reductase inhibitors
include ejaculation disorders and
gynaecomastia
3. Possible presentation include recurrent UTI
4. 5α-reductase inhibitors typically decrease
the PSA
5. More common in black men.
LUTS: definition
• Storage (irritative) symptoms:
– Urgency
– Urinary frequency
– Nocturia
– Urinary incontinence
• Voiding (obstructive) symptoms
– Hesitancy, poor stream, terminal dribbling
Causes of LUTS
• Obstructive
– BPH
– Prostate/bladder/rectal cancer
– Bladder neck/urethral strictures
– Antimuscarinic drugs
– Autonomic neuropathy/neurogenic bladder
Causes of LUTS
• Irritative
– BPH
– Bladder/prostate cancer
– Infection
– Bladder stones
– Neurological
• Dementia
• Diabetes
• Stroke
Assessment
• History – type of LUTS, duration of Sx,
how bothersome are they?
• Examination – abdomen (distended
bladder), external genitalia, DRE
• International Prostate Symptom Score:
– Used to assess severity of symptoms
– Score of 0-5 for seven symptoms (total 35):
• 0-7 – mildly symptomatic
• 8-19 – moderately symptomatic
• 20-35 – severely symptomatic
•
A 62 year-old man presents with
nocturia, hesitancy and terminal
dribbling. DRE reveals a moderately
enlarged prostate with no irregular
features. PSA1.3 What is the most
appropriate mx?
1.
2.
3.
4.
5.
Alpha antagonist
5-alpha reductase inhibitor
Non-urgent referral for TURP
Empirical tx with cipro for 2 weeks
Urgent referral to urology.
•
A patient is started on finasteride for the
management of BPH. How long should
the patients be told that treatment may
take to be effective?
1.
2.
3.
4.
5.
Within 8hrs of taking the tablet
Within 3 days
Up to 7 days
Up to 4 weeks
Up to 6 months
Management
• Urine dip +/- culture
• U&E
– Chronic retention
– Recurrent UTI
– Hx of renal stones
• PSA
• Urinary frequency-volume chart
– Ask patient to note down when they drink fluid/pass
water and to comment on type of fluid
– Allows to differentiate between frequency of urine,
polyuria and nocturia
• Obstructive symptoms
– Lifestyle changes.
– Alpha blocker: e.g tamsulosin
– 5α – reductase inhibitors
• Irritative symptoms
– Exclude/manage treatable causes
– Urine containment devices
– Supervised bladder retraining
– Anticholinergics e.g oxybutinin
Thank You