Lower urinary tract symptoms
Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms, that affect approximately 40% of older men.[1] LUTS is a recent term for what used to be known as prostatism.[2]
Contents
Symptoms and signs
Symptoms can be categorised into:
Filling (Storage) or irritative symptoms
- Increased frequency of urination
- Increased urgency of urination
- Painful urination
- Excessive passage of urine at night
Voiding or obstructive symptoms
- Poor stream (unimproved by straining)[3]
- Hesitancy (worsened if bladder is very full)[3]
- Terminal dribbling
- Incomplete voiding
- Overflow incontinence (occurs in chronic retention)[3]
- Episodes of near retention[3]
As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.[2] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[4]
Causes
- 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[5][6][7]
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,[8] 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.
ICD 9 CM
- 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
Treatment
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.[9]
Voiding position
Other treatments include lifestyle advice,[10] for example sitting down while urinating. A meta-analysis[11] 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.
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.[12]
- Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[13]
- 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%.
References
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- NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
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<references />, or <references group="..." />- ↑ RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell's Urology. WB Saunders Co 2002; chapt 38, p1309.
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- ↑ Clinical Knowledge Summary; Urological cancer — suspected
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- ↑ The Prostate-Specific Antigen (PSA) Test: Q & A — National Cancer Institute
- ↑ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
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- ↑ Enlarged prostate gland —treatment, symptoms and cause
