Karolinska-KIx - SP | S1V1 VIDEO: WHAT IS LUTS?

DR LARS All right. Welcome back to the first session here in the LUTS section of this course. LUTS is
HENNINGSOHN: lower urinary tract symptoms, and these are symptoms during the micturition cycle. The

micturition has two different phases.

The first phase is the storage phase. And during storage, the bladder and the lower urinary
tract can produce a couple of symptoms. The first symptom is usually urgency. Urgency is the

feeling that you have to go to the toilet and void.

If you do that, it adds up to frequency, which is another symptom from the lower urinary tract

during the storage phase or filling phase of the bladder, when the bladder fills up. Frequency

during nighttime is also a symptom, and that is called nocturia. Usually at nighttime, everyone
should sleep. But having symptoms and going to the toilet adds up to nocturia.

Another symptom during the storage phase of the bladder, when the bladder should store the

urine, is leakage of urine. That is called incontinence. So we have four symptoms during the
storage phase, urgency, frequency, nocturia, and incontinence.

The other phase of micturition is emptying of the bladder or voiding. So during the emptying,
when the bladder goes from full bladder to press out the urine, we can have some symptoms

here also. The first symptom is starting problems or hesitancy. It could be problematic to start
up micturition. So hesitancy is the first symptom.

When a patient or a person has problems with starting up their micturition, they will probably
try to help the bladder a little bit, and that means usually that the patient strains and

compresses the abdominal muscles to increase the pressure over the bladder to empty. That

is called straining micturition or Valsalva micturition.

It's impossible to keep the pressure from the abdomen on the lower urinary tract for a long

time. So the patient has to breathe a little bit. When the patient then starts to breathe, the

weak stream, which is also a symptom, goes down again. So we can have a variable stream
or even miction in portions. That is called intermittency. Miction in portions means that one

portion comes first, and then another portion after a second, or up to a couple of minutes.

Urination during a long time is also a symptom from the lower urinary tract during the emptying

phase. And then exactly at the end of micturition, we have two symptoms that can appear. And
the first one is dribbling. Dribbling means that the patient loses a few drops or up to a couple
of milliliters when the actual micturition should have stopped already. That could be really

disturbing for the patient. It's kind of an incontinence, but it comes immediately after the

emptying phase, and therefore, it is called post-micturition symptom.

The other symptom that also is a post-micturition symptom is the feeling of residual. That

means the feeling that there's something still in the bladder that hasn't come out. That is also
not natural to feel. The bladder should be able to empty fully in a fully normal patient.

Adding to this, we have another symptom during micturition, which is called dysuria. And that
is a little different symptom. This is the pain during micturition. Pain during micturition is not

normal. These are the symptoms from the lower urinary tract, the LUTS symptoms, the

symptoms during the storage phase and the filling phase of the bladder and the symptoms of
the emptying of the bladder, the emptying symptoms.