LUTS


What are lower urinary tract symptoms (LUTS)?

LUTS (lower urinary tract symptoms) is a term used to describe a range of symptoms related to problems of the lower urinary tract (bladder, prostate and urethra). LUTS are broadly grouped into voiding (obstructive) symptoms or storage (irritative) symptoms. A man may have mainly voiding symptoms, mainly storage symptoms, or a combination of both.

Voiding or obstructive symptoms

Storage or irritative symptoms

Hesitancy – a longer than usual wait for the stream of urine to begin Nocturia – a need to pass urine two or more times during the night.
Weak and poorly directed stream of urine Urgency – an urgent feeling of needing to urinate
Straining to urinate Frequency – a short time between needing to urinate
Dribbling after urination has finished or an irregular stream Urge incontinence – a sudden, intense urge to urinate followed by an uncontrolled loss of urine
Chronic urinary retention – not all the urine is passed from the bladder causing a need to urinate more often  
Overflow or paradoxical incontinence – urine overflows from a full bladder uncontrollably even though normal urination can be difficult to start

 

How common are LUTS?

LUTS are a major burden for the ageing male population. They have significant effects on quality of life in older men. Approximately 30% of men aged 50 and older have moderate to severe LUTS. This is a very large group potentially requiring treatment. Although LUTS do not usually cause severe illness, they can considerably reduce patients’ quality of life, and may point to serious pathology of the urogenital tract

What causes LUTS?

LUTS, especially if pain on urination (dysuria) is also present, may be caused by an acute problem such as a urinary tract infection, inflammation of the prostate gland (prostatitis) or less commonly, bladder stones.

Storage symptoms or overactive bladder (OAB – defined as urgency, with or without urge incontinence, usually with frequency and nocturia) may indicate an underlying chronic medical condition such as obesity diabetes (high glucose levels in the blood), high blood pressure or obstructive sleep apnoea, or be due to the effects of smoking.

Lifestyle factors including drinking fluids late at night, too much alcohol or caffeine, or low levels of physical activity can make storage symptoms worse.

Voiding symptoms are usually due to a blockage of the outlet of the bladder making it more difficult to pass urine. The blockage may be caused by an enlarged prostate gland or a urethral stricture (scarring of the urethra). Enlargement of the prostate gland can lead to both storage and voiding symptoms.

Other causes of LUTS include some medicines and neurological diseases such as stroke and Parkinson’s disease.
There are also links between LUTS and depression and erectile dysfunction.

How can one prevent LUTS ?

A man is less likely to get LUTS if he has a healthy lifestyle and body weight, does not smoke and gets treatment for any medical conditions such as diabetes, high blood pressure or sleep apnoea.

For a man with LUTS, reducing caffeine and alcohol intake (these substances can irritate the bladder), avoiding constipation (straining to pass stools can affect pelvic floor muscles, which are important for both bowel and bladder control), and reducing body weight may help to improve the symptoms.

When should I see a Urologist for LUTS?

LUTS is not just a normal part of ageing so it is a good idea to see your urologist if you notice any changes to urination, particularly if the symptoms are affecting your quality of life or interfering with normal daily activities. Many people think that urinary symptoms in men are a sign of prostate cancer. This is not true. Prostate cancer may sometimes be present with urinary symptoms but most often it is not and the LUTS have other causes.

How are LUTS diagnosed?

The tests used to diagnose LUTS depend on the likely cause, based on the man’s age and details given in the medical history, including the type of symptoms, the presence of other health conditions, such as diabetes, and medicines the man may be taking.


The tests may include the following:

The urologist places a gloved finger in the rectum (back passage) to check the size and shape of the prostate, and to feel for problems with the prostate gland.

UROFLOWMETRY


Uroflowmetry procedure measure of the quantity of urine excreted in a specified period of time which is also called as Urine flow rate.

Uroflowmetry is a simple, non invasive diagnostic screening procedure used to calculate the amount of urine (volume), flow rate in seconds, and length of time until completion of the void.
Continuous recording of urine flow by means of a device consisting of a cylinder placed on a transducer that weighs the urine entering the cylinder during voiding and plots the flow rate on a time scale.


When should one gets a Uroflowmetry?


How is uroflowmetry done?

Uroflowmetry is best done when you have a full bladder. Urologist ask to patient not urinate for 2 hours before the test. Drink extra fluids so you will have plenty of urine for the test. Generally, no prior preparation, such as fasting or sedation, is required.

Patient will urinate in a special urinal or toilet with a machine that has a measuring device.

Patient will be asked to begin urinating after the machine has started. When you finish, the machine will create a report for your health care provider.

What are the conclusions drawn from Uroflowmetry Test?

Changes in the urine flow rate can be indicative of

How are LUTS treated?

When deciding on the best treatment, the urologist will take into account the type of LUTS, the cause of the LUTS and other factors such as the degree of bother caused by the LUTS and lifestyle factors. Lifestyle changes or managing other health conditions such as diabetes or hypertension may be the first option.

If symptoms are not very bothersome, the best approach may be to monitor the LUTS through regular checks with the urologist. If the LUTS are bothersome, oral medicines (tablets) can help. The medicine suggested by the urologist will depend on the type and cause of LUTS.

In some cases several medicines may be tried to see whether they improve the symptoms. Surgery is only done in severe cases of prostate enlargement or other serious causes of obstruction. Surgery is the most effective treatment for relieving symptoms caused by an enlarged prostate.

LUTS TREATMENTS


Management of underlying conditions and lifestyle measures

Oral medicines (tablets)