Lower urinary tract symptoms in men
Lower urinary tract symptoms (LUTS) in men are very common and are present in the majority of men aged > 50 years. They are most commonly secondary to benign prostatic hyperplasia (BPH) but other causes should be considered including prostate cancer.
It is useful to classify the symptoms into 3 broad groups.
| Voiding |
Storage |
Post-micturition |
| HesitancyPoor or intermittent streamStrainingIncomplete emptyingTerminal dribbling |
UrgencyFrequencyNocturiaUrinary incontinence |
Post-micturition dribblingSensation of incomplete emptying |
Examination
- urinalysis: exclude infection, check for haematuria
- digital rectal examination: size and consistency of prostate
- a PSA test may be indicated, but the patient should be properly counselled first
It is useful to get the patient to complete the following to guide management:
- urinary frequency-volume chart: distinguish between urinary frequency, polyuria, nocturia, and nocturnal polyuria.
- International Prostate Symptom Score (IPSS): assess the impact on the patient's life. This classifies the symptoms as mild, moderate or severe
Management
Predominately voiding symptoms
- conservative measures include: pelvic floor muscle training, bladder training, prudent fluid intake and containment products
- if 'moderate' or 'severe' symptoms offer an alpha-blocker
- if the prostate is enlarged and the patient is 'considered at high risk of progression' then a 5-alpha reductase inhibitor should be offered
- if the patient has an enlarged prostate and 'moderate' or 'severe' symptoms offer both an alpha-blocker and 5-alpha reductase inhibitor
- if there are mixed symptoms of voiding and storage not responding to an alpha blocker then a antimuscarinic (anticholinergic) drug may be added
Predominately overactive bladder
- conservative measures include moderating fluid intake