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]
Symptoms can be categorised into:
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]
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 will depend on the cause, if one is found. For example; with a UTI, a course of antibiotics would be given[ medical citation needed]; appropriate medication would be administered to treat benign prostatic hyperplasia.
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]
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 of LUTS can include:
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]
Symptoms can be categorised into:
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]
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 will depend on the cause, if one is found. For example; with a UTI, a course of antibiotics would be given[ medical citation needed]; appropriate medication would be administered to treat benign prostatic hyperplasia.
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]
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 of LUTS can include: