Lower urinary tract symptoms
Lower urinary tract symptoms | |
---|---|
Other names | LUTS, prostatism |
Specialty | Urology |
Lower urinary tract symptoms (LUTS) refer to a group of clinical
Symptoms and signs
Symptoms can be categorised into:
Filling (storage) or irritative symptoms
- Increased frequency of urination
- Increased urgency of urination
- Urge incontinence
- Excessive passage of urine at night
Voiding or obstructive symptoms
- Poor stream[8] (unimproved by straining)
- ]
- Terminal dribbling[8]
- Incomplete voiding[8]
- Urinary retention[9]
- Overflow incontinence (occurs in chronic retention)[9]
- Episodes of near retention[9]
As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.[7] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[10] Also, recently a report of lower urinary tract symptoms even with malignant features in the prostate failed to be associated with prostate cancer after further laboratory investigation of the biopsy.[9]
Causes
- Benign prostatic hyperplasia (BPH)
- Bladder stone
- Cancer of the bladder and prostate
- Detrusor muscle weakness and/or instability
- Diabetes
- Use of ketamine[11]
- Neurological conditions; for example multiple sclerosis, spinal cord injury, cauda equina syndrome
- Prostatitis, including IgG4-related prostatitis[12][13][14]
- Urethral stricture
- Urinary tract infections (UTIs)[15]
Diagnosis
The International Prostate Symptom Score (IPSS) can be used to gauge the symptoms, along with physician examination. Other primary and secondary tests are often carried out, such as a PSA (Prostate-specific antigen) test,[16] urinalysis, ultrasound, urinary flow studies, imaging, temporary prostatic stent placement, prostate biopsy and/or cystoscopy.
Treatment
Treatment will depend on the cause, if one is found. For example; with a UTI, a course of
Lifestyle changes
Other treatments include lifestyle advice; for example, avoiding dehydration in recurrent cystitis.[citation needed]
Men with prostatic hypertrophy are advised to sit down whilst urinating.[17] A 2014 meta-analysis found that, for elderly males with LUTS, sitting to urinate meant there was a decrease in post-void residual volume (PVR, ml), increased maximum urinary flow (Qmax, ml/s), which is comparable with pharmacological intervention, and decreased the voiding time (VT, s).[18] The improved urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.[18]
Physical activity
Physical activity has been recommended as a treatment for urinary tract symptoms. A 2019 Cochrane review of six studies involving 652 men assessing the effects of physical activity alone, physical activity as a part of a self-management program, among others.[19] The evidence from this review states that there are important uncertainties whether physical activity is helpful in men experiencing urinary symptoms caused by benign prostatic hyperplasia.[19]
Medications
With benign prostatic enlargement causes of LUTS, people may be offered a variety of medications (as a single drug or combining them) when there are persistent moderate symptoms:[20]
- Alpha blockers
- 5-alpha reductase inhibitors
- Phosphodiesterase inhibitors
- Muscarinic receptor antagonists
- Plants extracts (phytotherapy)
- Beta-3 agonist
If medical treatment fails, or is not an option; a number of surgical techniques to destroy part or all of the prostate have been developed.[citation needed]
Surgical treatment
Surgical treatment of LUTS can include:
- Ablation procedures – used in treating both bladder tumours[21] and bladder outlet obstruction, such as prostate conditions.[22]
- Bladder-neck incision (BNI)
- Removal of the prostate – open, robotic, and endoscopic techniques are used.
- Stenting of the prostate[23] and urethra.
- Transurethral resection of the prostate (TURP)
- Transurethral microwave thermotherapy
- Urethral dilatation, a common treatment for strictures.
Epidemiology
- Prevalence increases with age. The prevalence of nocturia in older men is about 78%. Older men have a higher incidence of LUTS than older women.[24]
- Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[25]
- Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.[citation needed]
References
- ^ "Lower Urinary Tract Symptoms in Women | Doctor". patient.info. Retrieved 7 September 2017.
- PMID 35846856.
- PMID 18554695.
- S2CID 28287734.
- ^ Roehrborn CG, McConnell JD (2002). "Chapter 38: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia.". Campell's Urology. WB Saunders Co. p. 1309.
- S2CID 879639.
- ^ PMID 8173393.
- ^ PMID 21923844.
- ^ PMID 16986059.
- ^ Clinical Knowledge Summary; Urological cancer – suspected
- PMID 22416998.
- PMID 23266239.
- PMID 16946571.
- PMID 18084121.
- PMID 28971220.
- ^ "Prostate-Specific Antigen (PSA) Test – NCI". www.cancer.gov. March 21, 2022.
- ^ De Jong Y, Pinckaers JH, Ten Brinck RM, Lycklama à Nijeholt AA. "Influence of voiding posture on urodynamic parameters in men: a literature review" (PDF). Nederlands Tijdschrift voor urologie. Retrieved 2014-07-02.
- ^ PMID 25051345.
- ^ PMID 30953341.
- ^ Sumedia-Online Professionals. "EAU Guidelines: Management of Non-neurogenic Male LUTS". Uroweb. Retrieved 2021-02-15.
- S2CID 8976911.
- PMID 23332997.
- ^ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
- S2CID 7709214.
- ^ Enlarged prostate gland – treatment, symptoms and cause
Further reading
- Speakman MJ, Kirby RS, Joyce A, Abrams P, Pocock R (May 2004). "Guideline for the primary care management of male lower urinary tract symptoms". BJU International. 93 (7): 985–990. PMID 15142148.
- Juliao AA, Plata M, Kazzazi A, Bostanci Y, Djavan B (January 2012). "American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited". Current Opinion in Urology. 22 (1): 34–39. S2CID 41964732.
- NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
External links
- LUTS in men – Patient.info
- LUTS in women – Patient.info