_Lower urinary tract symptoms (LUTS) are storage, voiding and postmicturition symptoms affecting the lower urinary tract. LUTS can significantly reduce men's quality of life, and may point to serious pathology of the urogenital tract.1 Symptoms are often nonspecific and large studies of patients have failed to show any correlation between LUTS and a specific diagnosis.2 LUTS are common and not necessarily a reason for suspecting prostate cancer. Patients tend to fall into 3 categories:
Mild symptoms: mainly require reassurance and exclusion of cancer or risk of future complications.
Troublesome symptoms, suitable for medical treatment.
Those requiring surgical treatment.
Lower urinary tract symptoms (LUTS) are a common problem, especially for older men. It has been reported that 90% of men aged 50 to 80 years suffer from potentially troublesome LUTS. The prevalence of storage symptoms increases from 3% in men aged 40 to 44 years to 42% in those aged 75 years or older.1
The prevalence of nocturia in older men is about 78%. Older men have a higher incidence of LUTS than older women.4
Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia (BPH).
Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.
Flow-rate and post-void residual volume measurement.
Urinary frequency volume chart.
Cystoscopy and/or ultrasound imaging of the upper urinary tract only when clinically indicated, e.g. history of: recurrent infection, sterile pyuria, haematuria, profound symptoms, pain or chronic retention.
Multichannel cystometry if men are considering surgery.
Offer pad tests only if the degree of urinary incontinence needs to be measured.
Consider PSA testing if: o LUTS are suggestive of bladder outlet obstruction secondary to prostate enlargement. o The prostate feels abnormal on rectal examination. o The patient is concerned about prostate cancer.