Lower urinary tract symptoms

Short description: Group of clinical symptoms

"LUTS" redirects here. For other uses, see Luts.

Lower urinary tract symptoms

Other names| LUTS, prostatism
Specialty| Urology

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]

## Contents

* 1 Symptoms and signs
* 1.1 Filling (storage) or irritative symptoms
* 1.2 Voiding or obstructive symptoms
* 2 Causes
* 3 Diagnosis
* 4 Treatment
* 4.1 Lifestyle changes
* 4.2 Medications
* 4.3 Surgical treatment
* 5 Epidemiology
* 6 References
* 7 Further reading
* 8 External links

## 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)
* Hesitancy[8] (worsened if bladder is very full)[9]
* Terminal dribbling[8]
* Incomplete voiding[8]
* Urinary retention[10]
* Overflow incontinence (occurs in chronic retention)[10]
* Episodes of near retention[10]

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.[11] 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.[10]

## Causes

* Benign prostatic hyperplasia (BPH)
* Bladder stone
* Cancer of the bladder and prostate
* Detrusor muscle weakness and/or instability
* Diabetes
* Use of ketamine[12]
* Neurological conditions; for example multiple sclerosis, spinal cord injury, cauda equina syndrome
* Prostatitis, including IgG4-related prostatitis[13][14][15]
* Urethral stricture
* Urinary tract infections (UTIs)[16]

## 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,[17] 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

Men with prostatic hypertrophy are advised to sit down whilst urinating.[18] 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).[19] The improved urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.[19]

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.[20] 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.[20]

### 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:[21]

* Alpha blockers
* 5-alpha reductase inhibitors
* Phosphodiesterase inhibitors
* Muscarinic receptor antagonists
* Plants extracts (phytotherapy)
* Beta-3 agonist

### Surgical treatment

Surgical treatment of LUTS can include:

* Ablation procedures – used in treating both bladder tumours[22] and bladder outlet obstruction, such as prostate conditions.[23]
* Bladder-neck incision (BNI)
* Removal of the prostate – open, robotic, and endoscopic techniques are used.
* Stenting of the prostate[24] 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.[25]
* Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[26]

## 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. 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. ↑ Bailey & Love's Short Practice of Surgery (28th ed.). CRC Press. 2023. pp. 1523. ISBN 978-0-367-54811-7.
10. ↑ 10.0 10.1 10.2 10.3 "Pathophysiology of lower urinary tract symptoms in the aging male population". Reviews in Urology 7 Suppl 7 (7): S3–S11. 2005. PMID 16986059.
11. ↑ Clinical Knowledge Summary; Urological cancer – suspected
12. ↑ "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.
13. ↑ "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.
14. ↑ "IgG4-associated prostatitis complicating autoimmune pancreatitis". Internal Medicine 45 (15): 897–901. 1 Sep 2006. doi:10.2169/internalmedicine.45.1752. PMID 16946571.
15. ↑ "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.
16. ↑ "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.
17. ↑ "Prostate-Specific Antigen (PSA) Test – NCI". March 21, 2022. https://www.cancer.gov/types/prostate/psa-fact-sheet.
18. ↑ "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.
19. ↑ 19.0 19.1 "Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis". PLOS ONE 9 (7). 2014. doi:10.1371/journal.pone.0101320. PMID 25051345. Bibcode: 2014PLoSO...9j1320D.
20. ↑ 20.0 20.1 "Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction". The Cochrane Database of Systematic Reviews 4. April 2019. doi:10.1002/14651858.CD012044.pub2. PMID 30953341.
21. ↑ 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.
22. ↑ "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.
23. ↑ "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.
24. ↑ Fitzpatrick, J. M. (1992). Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone. ISBN 0-443-04642-5.
25. ↑ "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.
26. ↑ 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

Classification|

* ICD-10: R30, R33, R35, R39
* ICD-9-CM: 600.00 600.01, 600.20, 600.21, 600.90, 600.91

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* LUTS in men – Patient.info
* LUTS in women – Patient.info

* v
* t
* e

Symptoms and signs: urinary system (R30–R39, 788)

Pain|

* Renal colic
* Costovertebral angle tenderness
* Dysuria
* Vesical tenesmus

Control|

* Urinary incontinence
* Enuresis
* Diurnal enuresis
* Giggling
* Nocturnal enuresis
* Post-void dribbling
* Stress
* Urge
* Overflow
* Urinary retention

Volume|

* Oliguria
* Anuria
* Polyuria

Other|

* Lower urinary tract symptoms
* Nocturia
* Urinary urgency
* Urinary frequency
* Extravasation of urine
* Extrarenal uremia
* Urinoma

Eponymous|

* Addis count
* Brewer infarcts
* Lloyd's sign
* Mathe's sign

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