Lower urinary tract symptoms
| 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 and signs
[edit]Symptoms can be categorised into:
Filling (storage) or irritative symptoms
[edit]- Increased frequency of urination
- Increased urgency of urination
- Urge incontinence
- Excessive passage of urine at night
Voiding or obstructive symptoms
[edit]- Poor stream[8] (unimproved by straining)
- Hesitancy[8] (worsened if bladder is very full)[9]
- Terminal dribbling[8]
- Incomplete voiding[8]
- Urinary retention[10]
- Overflow incontinence (occurs in chronic retention)[10]
- Episodes of near retention[10]
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.[11] 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.[10]
Causes
[edit]- Benign prostatic hyperplasia (BPH)
- Bladder stone
- Cancer of the bladder and prostate
- Detrusor muscle weakness and/or instability
- Diabetes
- Use of ketamine[12]
- Neurological conditions; for example multiple sclerosis, spinal cord injury, cauda equina syndrome
- Prostatitis, including IgG4-related prostatitis[13][14][15]
- Urethral stricture
- Urinary tract infections (UTIs)[16]
Diagnosis
[edit]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,[17] urinalysis, ultrasound, urinary flow studies, imaging, temporary prostatic stent placement, prostate biopsy and/or cystoscopy.
Treatment
[edit]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.
Lifestyle changes
[edit]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.[18] 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).[19] The improved urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.[19]
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.[20] 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.[20]
Medications
[edit]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:[21]
- 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]
Surgical treatment
[edit]Surgical treatment of LUTS can include:
- Ablation procedures – used in treating both bladder tumours[22] and bladder outlet obstruction, such as prostate conditions.[23]
- Bladder-neck incision (BNI)
- Removal of the prostate – open, robotic, and endoscopic techniques are used.
- Stenting of the prostate[24] and urethra.
- Transurethral resection of the prostate (TURP)
- Transurethral microwave thermotherapy
- Urethral dilatation, a common treatment for strictures.
Epidemiology
[edit]- 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.[25]
- Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[26]
- 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]
References
[edit]- ^ "Lower Urinary Tract Symptoms in Women | Doctor". patient.info. Retrieved 7 September 2017.
- ^ Tavoosian A, Reis LO, Aluru P, Khajavi A, Aghamir SM (2022-08-01). "Comparison of Tamsulosin and Tadalafil effects in LUTS treatment considering patients' atherosclerosis risk level". Annals of Medicine and Surgery. 80: 104137. doi:10.1016/j.amsu.2022.104137. ISSN 2049-0801. PMC 9283796. PMID 35846856.
- ^ Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E (August 2008). "Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years". Urology. 72 (2): 318–321. doi:10.1016/j.urology.2008.03.057. PMC 2597492. PMID 18554695.
- ^ Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P (October 2011). "Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction". BJU International. 108 (7): 1132–1138. doi:10.1111/j.1464-410X.2010.09993.x. PMID 21231991. S2CID 28287734.
- ^ Roehrborn CG, McConnell JD (2002). "Chapter 38: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia.". Campell's Urology. WB Saunders Co. p. 1309.
- ^ Takahashi S, Takei M, Nishizawa O, Yamaguchi O, Kato K, Gotoh M, et al. (January 2016). "Clinical Guideline for Female Lower Urinary Tract Symptoms". Lower Urinary Tract Symptoms. 8 (1): 5–29. doi:10.1111/luts.12111. PMID 26789539. S2CID 879639.
- ^ a b Abrams P (April 1994). "New words for old: lower urinary tract symptoms for "prostatism"". BMJ. 308 (6934): 929–930. doi:10.1136/bmj.308.6934.929. PMC 2539789. PMID 8173393.
- ^ a b c d Lukacz ES, Sampselle C, Gray M, Macdiarmid S, Rosenberg M, Ellsworth P, Palmer MH (October 2011). "A healthy bladder: a consensus statement". International Journal of Clinical Practice. 65 (10): 1026–1036. doi:10.1111/j.1742-1241.2011.02763.x. PMC 3206217. PMID 21923844.
- ^ Bailey & Love's Short Practice of Surgery (28th ed.). CRC Press. 2023. p. 1523. ISBN 978-0367548117.
- ^ a b c d Lepor H (2005). "Pathophysiology of lower urinary tract symptoms in the aging male population". Reviews in Urology. 7 Suppl 7 (7): S3–S11. PMC 1477625. PMID 16986059.
- ^ Clinical Knowledge Summary; Urological cancer – suspected
- ^ Winstock AR, Mitcheson L, Gillatt DA, Cottrell AM (December 2012). "The prevalence and natural history of urinary symptoms among recreational ketamine users". BJU International. 110 (11): 1762–1766. doi:10.1111/j.1464-410X.2012.11028.x. PMID 22416998.
- ^ Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Burattini M, Kirkali Z, Montorsi F (December 2013). "Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer". European Urology. 64 (6): 865–872. doi:10.1016/j.eururo.2012.11.056. PMID 23266239.
- ^ Yoshimura Y, Takeda S, Ieki Y, Takazakura E, Koizumi H, Takagawa K (1 Sep 2006). "IgG4-associated prostatitis complicating autoimmune pancreatitis". Internal Medicine. 45 (15): 897–901. doi:10.2169/internalmedicine.45.1752. PMID 16946571.
- ^ Nishimori I, Kohsaki T, Onishi S, Shuin T, Kohsaki S, Ogawa Y, et al. (17 Dec 2007). "IgG4-related autoimmune prostatitis: two cases with or without autoimmune pancreatitis". Internal Medicine. 46 (24): 1983–1989. doi:10.2169/internalmedicine.46.0452. hdl:10126/3103. PMID 18084121.
- ^ Khasriya R, Barcella W, De Iorio M, Swamy S, Gill K, Kupelian A, Malone-Lee J (July 2018). "Lower urinary tract symptoms that predict microscopic pyuria". International Urogynecology Journal. 29 (7): 1019–1028. doi:10.1007/s00192-017-3472-7. PMC 6004270. PMID 28971220.
- ^ "Prostate-Specific Antigen (PSA) Test – NCI". www.cancer.gov. March 21, 2022.
- ^ De Jong Y, Pinckaers JH, Ten Brinck RM, Lycklama à Nijeholt AA. "Influence of voiding posture on urodynamic parameters in men: a literature review" (PDF). Nederlands Tijdschrift voor urologie. Retrieved 2014-07-02.
- ^ a b de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM (2014). "Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis". PLOS ONE. 9 (7): e101320. Bibcode:2014PLoSO...9j1320D. doi:10.1371/journal.pone.0101320. PMC 4106761. PMID 25051345.
- ^ a b Silva V, Grande AJ, Peccin MS, et al. (Cochrane Urology Group) (April 2019). "Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction". The Cochrane Database of Systematic Reviews. 4: CD012044. doi:10.1002/14651858.CD012044.pub2. PMC 6450803. PMID 30953341.
- ^ Sumedia-Online Professionals. "EAU Guidelines: Management of Non-neurogenic Male LUTS". Uroweb. Retrieved 2021-02-15.
- ^ Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, et al. (April 2015). "Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014". World Journal of Urology. 33 (4): 571–579. doi:10.1007/s00345-014-1337-y. PMID 24935098. S2CID 8976911.
- ^ Elshal AM, Elmansy HM, Elhilali MM (March 2013). "Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes". Urology. 81 (3): 634–639. doi:10.1016/j.urology.2012.11.042. PMID 23332997.
- ^ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
- ^ Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, et al. (September 2003). "The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study". BJU International. 92 (4): 409–414. doi:10.1046/j.1464-410x.2003.04369.x. PMID 12930430. S2CID 7709214.
- ^ Enlarged prostate gland – treatment, symptoms and cause
Further reading
[edit]- Speakman MJ, Kirby RS, Joyce A, Abrams P, Pocock R (May 2004). "Guideline for the primary care management of male lower urinary tract symptoms". BJU International. 93 (7): 985–990. doi:10.1111/j.1464-410X.2004.04765.x. PMID 15142148.
- Juliao AA, Plata M, Kazzazi A, Bostanci Y, Djavan B (January 2012). "American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited". Current Opinion in Urology. 22 (1): 34–39. doi:10.1097/MOU.0b013e32834d8e87. PMID 22123290. S2CID 41964732.
- NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
External links
[edit]- LUTS in men – Patient.info
- LUTS in women – Patient.info