Medicine:Lower urinary tract symptoms

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Short description: Group of clinical symptoms
Lower urinary tract symptoms
Other namesLUTS, prostatism
SpecialtyUrology

Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men[1]—over 40% of older men are affected[2][3][4][5]—but lower urinary tract symptoms also affect women.[6] The condition is also termed prostatism in men, but LUTS is preferred.[7]

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

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

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 antibiotics would be given; appropriate medication would be administered to treat benign prostatic hyperplasia.

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]

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

  1. ↑ "Lower Urinary Tract Symptoms in Women | Doctor". https://patient.info/doctor/lower-urinary-tract-symptoms-in-women-pro. 
  2. ↑ "Comparison of Tamsulosin and Tadalafil effects in LUTS treatment considering patients' atherosclerosis risk level" (in en). Annals of Medicine and Surgery 80: 104137. 2022-08-01. doi:10.1016/j.amsu.2022.104137. ISSN 2049-0801. PMID 35846856. 
  3. ↑ "Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years". Urology 72 (2): 318–321. August 2008. doi:10.1016/j.urology.2008.03.057. PMID 18554695. 
  4. ↑ "Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction". BJU International 108 (7): 1132–1138. October 2011. doi:10.1111/j.1464-410X.2010.09993.x. PMID 21231991. 
  5. ↑ "Chapter 38: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia.". Campell's Urology. WB Saunders Co. 2002. p. 1309. 
  6. ↑ "Clinical Guideline for Female Lower Urinary Tract Symptoms". Lower Urinary Tract Symptoms 8 (1): 5–29. January 2016. doi:10.1111/luts.12111. PMID 26789539. 
  7. ↑ 7.0 7.1 "New words for old: lower urinary tract symptoms for "prostatism"". BMJ 308 (6934): 929–930. April 1994. doi:10.1136/bmj.308.6934.929. PMID 8173393. 
  8. ↑ 8.0 8.1 8.2 8.3 "A healthy bladder: a consensus statement". International Journal of Clinical Practice 65 (10): 1026–1036. October 2011. doi:10.1111/j.1742-1241.2011.02763.x. PMID 21923844. 
  9. ↑ 9.0 9.1 9.2 9.3 "Pathophysiology of lower urinary tract symptoms in the aging male population". Reviews in Urology 7 Suppl 7 (7): S3–S11. 2005. PMID 16986059. 
  10. ↑ Clinical Knowledge Summary; Urological cancer — suspected
  11. ↑ "The prevalence and natural history of urinary symptoms among recreational ketamine users". BJU International 110 (11): 1762–1766. December 2012. doi:10.1111/j.1464-410X.2012.11028.x. PMID 22416998. 
  12. ↑ "Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer". European Urology 64 (6): 865–872. December 2013. doi:10.1016/j.eururo.2012.11.056. PMID 23266239. 
  13. ↑ "IgG4-associated prostatitis complicating autoimmune pancreatitis". Internal Medicine 45 (15): 897–901. 1 Sep 2006. doi:10.2169/internalmedicine.45.1752. PMID 16946571. 
  14. ↑ "IgG4-related autoimmune prostatitis: two cases with or without autoimmune pancreatitis". Internal Medicine 46 (24): 1983–1989. 17 Dec 2007. doi:10.2169/internalmedicine.46.0452. PMID 18084121. 
  15. ↑ "Lower urinary tract symptoms that predict microscopic pyuria". International Urogynecology Journal 29 (7): 1019–1028. July 2018. doi:10.1007/s00192-017-3472-7. PMID 28971220. 
  16. ↑ The Prostate-Specific Antigen (PSA) Test: Q & A — National Cancer Institute
  17. ↑ "Influence of voiding posture on urodynamic parameters in men: a literature review". Nederlands Tijdschrift voor urologie. http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf. 
  18. ↑ 18.0 18.1 "Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis". PLOS ONE 9 (7): e101320. 2014. doi:10.1371/journal.pone.0101320. PMID 25051345. Bibcode: 2014PLoSO...9j1320D. 
  19. ↑ 19.0 19.1 "Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction". The Cochrane Database of Systematic Reviews 4: CD012044. April 2019. doi:10.1002/14651858.CD012044.pub2. PMID 30953341. 
  20. ↑ Sumedia-Online Professionals. "EAU Guidelines: Management of Non-neurogenic Male LUTS" (in en-US). https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/#5. 
  21. ↑ "Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014". World Journal of Urology 33 (4): 571–579. April 2015. doi:10.1007/s00345-014-1337-y. PMID 24935098. 
  22. ↑ "Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes". Urology 81 (3): 634–639. March 2013. doi:10.1016/j.urology.2012.11.042. PMID 23332997. 
  23. ↑ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
  24. ↑ "The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study". BJU International 92 (4): 409–414. September 2003. doi:10.1046/j.1464-410x.2003.04369.x. PMID 12930430. 
  25. ↑ Enlarged prostate gland —treatment, symptoms and cause

Further reading

  • "Guideline for the primary care management of male lower urinary tract symptoms". BJU International 93 (7): 985–990. May 2004. doi:10.1111/j.1464-410X.2004.04765.x. PMID 15142148. 
  • "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. January 2012. doi:10.1097/MOU.0b013e32834d8e87. PMID 22123290. 
  • NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.

External links

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