Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms, that affect approximately 40% of older men. LUTS is a recent term for what used to be known as prostatism.
Symptoms and signs
Symptoms can be categorised into:
Increased frequency of urination
Increased urgency of urination
Painful urination
Excessive passage of urine at night
Poor stream (unimproved by straining)
Hesitancy (worsened if bladder is very full)
Terminal dribbling
Incomplete voiding
Urinary retention
Overflow incontinence (occurs in chronic retention)
Episodes of near retention
As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer. Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.
Benign prostatic hyperplasia (BPH) with obstruction
Detrusor muscle weakness and/or instability
Urinary Tract Infection (UTI)
Chronic prostatitis
Urethral stricture
Urinary stone
Malignancy: prostate or bladder
Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome
IgG4-related prostatitis
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, urinalysis, ultrasound, urinary flow studies, imaging, temporary prostatic stent placement, prostate biopsy and/or cystoscopy.
Placement of a temporary prostatic stent as a differential diagnosis test can help identify whether LUTS symptoms are directly related to obstruction of the prostate or to other factors worth investigation.
600.00 Hypertrophy (benign) of prostate w/o urinary obstruction and other lower urinary tract symptoms (LUTS)
600.01 Hypertrophy (benign) of prostate with urinary obstruction and other LUTS
600.20 Benign localized hyperplasia of prostate w/o urinary obstruction and other LUTS
600.21 Benign localized hyperplasia of prostate with urinary obstruction and other LUTS
600.90 Hyperplasia of prostate, unspecified, w/o urinary obstruction and other LUTS
600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other LUTS
A number of techniques to destroy part or all of the prostate have been developed. First line of treatment is medical, which includes alpha-1 blockade and antiandrogens. If the medical treatment fails, surgical techniques are done. Techniques include:
TURP: trans-urethral removal of the prostate
Transurethral microwave thermotherapy
Thermal ablation
High intensity focused ultrasonography
Transurethral needle ablation
Laser prostatectomy.
Intraurethral prostatic stenting and balloon dilatation of the prostate.
Other treatments include lifestyle advice, for example sitting down while urinating. A meta-analysis found that, for elderly males with LUTS:
the post void residual volume (PVR, ml) was significantly decreased
the maximum urinary flow (Qmax, ml/s) was increased, comparable with pharmacological intervention
the voiding time (VT, s) was decreased
This urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.
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.
Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.
Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.
It is estimated that the lifetime risk of developing microscopic prostate cancer is about 30%, developing clinical disease 10%, and dying from prostate cancer 3%.
