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Lower urinary tract symptoms

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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]

Symptoms and signs

Symptoms can be categorised into:

Filling (Storage) or irritative symptoms

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.[2] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[3]

Causes

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,[7] 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:

Voiding position

Other treatments include lifestyle advice,[9] for example sitting down while urinating. A meta-analysis[10] 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.[11]
  • 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

  • NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
  1. ^ RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell's Urology. WB Saunders Co 2002; chapt 38, p1309.
  2. ^ a b
  3. ^ Clinical Knowledge Summary; Urological cancer — suspected
  4. ^
  5. ^
  6. ^
  7. ^ The Prostate-Specific Antigen (PSA) Test: Q & A — National Cancer Institute
  8. ^ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
  9. ^
  10. ^
  11. ^
  12. ^ Enlarged prostate gland —treatment, symptoms and cause
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