lower urinary tract symptoms

Symptoms can be categorised into:

• Increased frequency of urination
• Increased urgency of urination
• Urge incontinence
• Excessive passage of urine at night

• Poor stream{{cite journal | vauthors = Lukacz ES, Sampselle C, Gray M, Macdiarmid S, Rosenberg M, Ellsworth P, Palmer MH | title = A healthy bladder: a consensus statement | journal = International Journal of Clinical Practice | volume = 65 | issue = 10 | pages = 1026–1036 | date = October 2011 | pmid = 21923844 | pmc = 3206217 | doi = 10.1111/j.1742-1241.2011.02763.x }} (unimproved by straining)
• Hesitancy (worsened if bladder is very full){{Cite book |title=Bailey & Love's Short Practice of Surgery |publisher=CRC Press |year=2023 |isbn=978-0367548117 |edition=28th |pages=1523}}
• Terminal dribbling
• Incomplete voiding
• Urinary retention{{cite journal | vauthors = Lepor H | title = Pathophysiology of lower urinary tract symptoms in the aging male population | journal = Reviews in Urology | volume = 7 Suppl 7 | issue = 7 | pages = S3–S11 | date = 2005 | pmid = 16986059 | pmc = 1477625 | doi = }}
• Overflow incontinence (occurs in chronic retention)
• Episodes of near retention

As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer. 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 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.

{{^|To avoid gender bias; this list has been alphabetised. An alternative NPOV ordering system would be disease incidence; but would need data.}}

• Benign prostatic hyperplasia (BPH)
• Bladder stone
• Cancer of the bladder and prostate
• Detrusor muscle weakness and/or instability
• Diabetes
• Use of ketamine{{cite journal | vauthors = Winstock AR, Mitcheson L, Gillatt DA, Cottrell AM | title = The prevalence and natural history of urinary symptoms among recreational ketamine users | journal = BJU International | volume = 110 | issue = 11 | pages = 1762–1766 | date = December 2012 | pmid = 22416998 | doi = 10.1111/j.1464-410X.2012.11028.x | doi-access = free }}
• Neurological conditions; for example multiple sclerosis, spinal cord injury, cauda equina syndrome
• Prostatitis, including IgG4-related prostatitis{{cite journal | vauthors = Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Burattini M, Kirkali Z, Montorsi F | title = Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer | journal = European Urology | volume = 64 | issue = 6 | pages = 865–872 | date = December 2013 | pmid = 23266239 | doi = 10.1016/j.eururo.2012.11.056 }}{{cite journal | vauthors = Yoshimura Y, Takeda S, Ieki Y, Takazakura E, Koizumi H, Takagawa K | title = IgG4-associated prostatitis complicating autoimmune pancreatitis | journal = Internal Medicine | volume = 45 | issue = 15 | pages = 897–901 | date = 1 Sep 2006 | pmid = 16946571 | doi = 10.2169/internalmedicine.45.1752 | doi-access = free }}{{cite journal | vauthors = Nishimori I, Kohsaki T, Onishi S, Shuin T, Kohsaki S, Ogawa Y, Matsumoto M, Hiroi M, Hamano H, Kawa S | display-authors = 6 | title = IgG4-related autoimmune prostatitis: two cases with or without autoimmune pancreatitis | journal = Internal Medicine | volume = 46 | issue = 24 | pages = 1983–1989 | date = 17 Dec 2007 | pmid = 18084121 | doi = 10.2169/internalmedicine.46.0452 | doi-access = free | hdl = 10126/3103 | hdl-access = free }}
• Urethral stricture
• Urinary tract infections (UTIs){{cite journal | vauthors = Khasriya R, Barcella W, De Iorio M, Swamy S, Gill K, Kupelian A, Malone-Lee J | title = Lower urinary tract symptoms that predict microscopic pyuria | journal = International Urogynecology Journal | volume = 29 | issue = 7 | pages = 1019–1028 | date = July 2018 | pmid = 28971220 | pmc = 6004270 | doi = 10.1007/s00192-017-3472-7 }}

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,{{Cite web|url=https://www.cancer.gov/types/prostate/psa-fact-sheet|title=Prostate-Specific Antigen (PSA) Test – NCI|date=March 21, 2022|website=www.cancer.gov}} 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|date=September 2017}}; appropriate medication would be administered to treat benign prostatic hyperplasia.

Other treatments include lifestyle advice; for example, avoiding dehydration in recurrent cystitis.{{citation needed|date=April 2021}}

Men with prostatic hypertrophy are advised to sit down whilst urinating.{{cite web| vauthors = De Jong Y, Pinckaers JH, Ten Brinck RM, Lycklama à Nijeholt AA |title=Influence of voiding posture on urodynamic parameters in men: a literature review|url=http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf|access-date=2014-07-02|publisher=Nederlands Tijdschrift voor urologie}} 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).{{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | date = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }} The improved urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.

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.{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 | collaboration = Cochrane Urology Group }} 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.

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:{{cite web | author = Sumedia-Online Professionals |title=EAU Guidelines: Management of Non-neurogenic Male LUTS|url=https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/#5|access-date=2021-02-15|website=Uroweb|language=en-US}}

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

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|date=April 2021}}

Surgical treatment of LUTS can include:

{{^|To avoid gender bias; this list has been alphabetised.)}}

• Ablation procedures – used in treating both bladder tumours{{cite journal | vauthors = Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, Merseburger AS, Herrmann TR | display-authors = 6 | title = Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014 | journal = World Journal of Urology | volume = 33 | issue = 4 | pages = 571–579 | date = April 2015 | pmid = 24935098 | doi = 10.1007/s00345-014-1337-y | s2cid = 8976911 }} and bladder outlet obstruction, such as prostate conditions.{{cite journal | vauthors = Elshal AM, Elmansy HM, Elhilali MM | title = Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes | journal = Urology | volume = 81 | issue = 3 | pages = 634–639 | date = March 2013 | pmid = 23332997 | doi = 10.1016/j.urology.2012.11.042 }}
• Bladder-neck incision (BNI)
• Removal of the prostate – open, robotic, and endoscopic techniques are used.
• Stenting of the prostate{{cite book |last=Fitzpatrick |first=J. M. |title=Non-surgical treatment of BPH |location=Edinburgh |publisher=Churchill Livingstone |year=1992 |isbn=0-443-04642-5 }} and urethra.
• Transurethral resection of the prostate (TURP)
• Transurethral microwave thermotherapy
• Urethral dilatation, a common treatment for strictures.

• 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.{{cite journal | vauthors = Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, Kiemeney L, Lee C | display-authors = 6 | title = The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study | journal = BJU International | volume = 92 | issue = 4 | pages = 409–414 | date = September 2003 | pmid = 12930430 | doi = 10.1046/j.1464-410x.2003.04369.x | s2cid = 7709214 }}
• 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.{{citation needed|date=April 2021}}

{{Reflist}}

{{refbegin}}

• {{cite journal | vauthors = Speakman MJ, Kirby RS, Joyce A, Abrams P, Pocock R | title = Guideline for the primary care management of male lower urinary tract symptoms | journal = BJU International | volume = 93 | issue = 7 | pages = 985–990 | date = May 2004 | pmid = 15142148 | doi = 10.1111/j.1464-410X.2004.04765.x | doi-access = }}
• {{cite journal | vauthors = Juliao AA, Plata M, Kazzazi A, Bostanci Y, Djavan B | title = American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited | journal = Current Opinion in Urology | volume = 22 | issue = 1 | pages = 34–39 | date = January 2012 | pmid = 22123290 | doi = 10.1097/MOU.0b013e32834d8e87 | s2cid = 41964732 }}
• NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.

{{refend}}

{{Medical resources

| ICD10 = {{ICD10|R30}}, {{ICD10|R33}}, {{ICD10|R35}}, {{ICD10|R39}}

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• [https://patient.info/doctor/lower-urinary-tract-symptoms-in-men-pro LUTS in men] – Patient.info
• [https://patient.info/doctor/lower-urinary-tract-symptoms-in-women-pro LUTS in women] – Patient.info

{{Urinary system symptoms and signs}}

{{DEFAULTSORT:Lower Urinary Tract Symptoms}}

Category:Urological conditions

Category:Symptoms and signs: Urinary system