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Lower urinary tract symptoms (LUTS) in men (Aetiology (Degenerative …
Lower urinary
tract symptoms
(LUTS) in men
Definition
Symptoms associated with pathology of the
lower urinary tract (ureters, bladders, urethra)
encompassing symptoms (voiding/storage)
Epidemiology
Common; 30% men >50y
Commonest cause is BPH
Storage>urge/stress in men
Aetiology
Degenerative
Urological:
stricture
Neurological:
spinal disc prolapse, autonomic neuropathy,
dementia, delerium, PD
Infection/inflammation
Urological:
UTI, STI, pyelonephritis, prostatitis,
interstitial cystitis
Vascular
Urological:
clot
Neurological:
stroke
Systemic:
CCF (fluid overload)
Trauma
Urological:
faecal impaction
Neurological:
spinal cord injury, nerve lesion
Metabolic
Urological:
urinary stones
Systemic:
RF, LF (fluid overload), constipation
Neoplastic
Urological:
BPH, polyps, bladder/prostate Ca
Neurological:
spinal tumour, CNS tumour
Autoimmune
Neurological:
MS
Iatrogenic
Urological/neurological:
post-surgical, post-epidural
Congenital
Urological:
phimosis
Neurological:
NTDs e.g. spina bifida
Endocrine
Systemic:
diabetes, adrenal insufficency
Drugs
Antimuscarinics, CCBs, diuretics,
SSRIs, A-blockers, benzos, sympathetomimetics,
alcohol, caffeine
Clinical
presentation
Storage symptoms
Urgency
Frequency
Nocturia
Incontinence
Incomplete evacuation
Voiding symptoms
Hesitancy
Poor stream
Terminal dribbling
Straining
Stranguary
Intermittency
Pathophysiology
Storage
Filling defect/irritation
Inability of bladder to effectively hold urine
Voiding
Issue with ejection of bladder contents
Often due to detrusor issue or blockage
Mechanisms
Urological problems, neurological problems
Systemic conditions, drugs
Diagnosis
Examination
PR examination
Impacted faeces, enlarged prostate
Male genital examination
Discharge, phimosis/stenosis,
skin changes (masses, ulcers etc.)
Abdominal examination
Distended bladder, palpable kidneys,
tender bladder/kidneys
Lower limb neurological examination
Saddle anaesthesia, weakness,
reflexes, coordination
Investigations
Imaging
Cystoscopy: visualise urethra/bladder
USS KUB: structural lesions
CT/MRI head/spine: if suspect CNS lesion
CT abdo/pelvis: malignancy
Urine
Dipstick, MCS (infection)
Bedside
Bladder diary (freq, volume)
IPSS chart (symptom severity and QoL)
Bloods
FBC, U+E (renal disease), LFTs (liver disease)
immune bloods (MS), glucose (DM), adrenal screen
Swabs
Urethral (CT/NG NAAT) if suspect STI
History
DH
Current meds, allergies
FH
Urological/neurological/systemic disease
Cancers
PMH
Urological/neurological conditions
systemic disease, prev abdo/pelvic surgery
SH
Occupation, smoking, alcohol
PC/HPC
LUTS (storage, voiding),
red flags (haematuria, weight loss, fevers)
Management
Conservative
Information, advice, support
Identify and treat cause
Lifestyle (fluids, weight loss, avoid caffeine/alcohol)
Bladder/pelvic floor training
Containment products (pads, catheter)