Lower urinary tract symptoms

Lower Urinary Tract Symptoms (LUTS) are a common problem affecting approximately 40% of older men [RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell's Urology. WB Saunders Co 2002; chapt 38, p1309.] . LUTS is a recent term for what used to be known as prostatism. [ [http://www.bmj.com/cgi/content/full/308/6934/929 New words for old: lower urinary tract symptoms for "prostatism" - Abrams 308 (6934): 929 - BMJ ] ]

ymptoms and signs

Symptoms can be categorised into:

Filling or irritative symptoms.

*Frequency
*Urgency
*Dysuria
*Nocturia

Voiding or obstructive symptoms.

*Poor stream
*Hesitancy
*Terminal dribbling
*Incomplete voiding
*Overflow incontinence (occurs in chronic retention)

As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer [Abrams P; New words for old: lower urinary tract symptoms for "prostatism". BMJ. 1994 Apr 9;):929-30.] . Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis [Clinical Knowledge Summary; Urological cancer - suspected] .

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. [Boyle P, Robertson C, Mazzetta C, et al; The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003 Sep;92(4):409-14. [abstract] ]

* Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia. [ [http://hcd2.bupa.co.uk/fact_sheets/html/bph.html Enlarged prostate gland - treatment, symptoms and cause ] ]

* 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%.

Assessment

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 test [ [http://www.cancer.gov/cancertopics/factsheet/detection/PSA The Prostate-Specific Antigen (PSA) Test: Q & A - National Cancer Institute ] ] , 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.

Possible causes of the lower urinary tract symptoms

* Benign prostatic hyperplasia (BPH) with obstruction
* Detrusor muscle weakness and/or instability
* Urinary Tract Infection (UTI)
* Chronic prostatitis
* Urinary stone
* Malignancy: prostate or bladder
* Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome

Treatment

A number of techniques to destroy part or all of the prostate have been developed.

Techniques include:
*Transurethral microwave thermotherapy
*Thermal ablation
*High intensity focused ultrasonography
* Transurethral needle ablation
*Laser prostatectomy.
*Intraurethral prostatic stenting and balloon dilatation of the prostate. [Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.]

Other treatments include lifestyle advice and alpha blocker therapy. Although surgical treatment is generally reserved for men who have failed or are unable to tolerate drug treatment, or for those who have developed complications

=References=
* British Association of Urological Surgeons; Primary care management of male lower urinary tract symptoms (LUTS). February 2004
* European Association of Urology Guideline; Benign Prostatic Hypertrophy (2004)
* NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.