ASSESSMENT ALGORITHM OF LUTS IN MEN AGED 40 YEARS OR OLDER

MALE LUTS MANAGE ACCORDING TO

EAU mLUTS TREATMENT
VOIDING SYMPTOMS ALGORITHM
 Weak or intermittent urinary stream
 Straining
 Hesitancy
 Terminal dribbling
 Incomplete emptying NO
STORAGE SYMPTOMS
 Urgency
 Frequency
 Urgency incontinence BOTHERSOME SYMPTOMS
 Nocturia
POST MICTURITION SYMPTOMS
 Post micturition dribbling

YES

HISTORY (+ SEXUAL FUNCTION)

SYMPTOM SCORE QUESTIONNAIRE (IPSS)
URINALYSIS
PHYSICAL EXAMINATION (DRE)
PSA KUB + PROSTATE ULTRASOUND
WITH PRE/POST VOID BLADDER
VOLUME)

MEDICAL TREATMENT ACCORDING TO

BENIGN CONDITIONS OF BLADDER
TREATMENT ALGORITHM
AND/OR PROSTATE WITH BASELINE
VALUES
PLAN TREATMENT

SURGICAL TREATMENT ACCORDING

TO TREATMENT ALGORITHM

European Association of Urology of 2022 Guidelines on Management of Non-

Neurogenic Male Lower Urinary Tract Symptoms (LUTS)
 TREATMENT ALGORITHM OF MALE LUTS USING MEDICAL AND/OR
CONSERVATIVE TREATMENT

Male LUTS
(WITHOUT INDICATIONS FOR SURGERY)

BOTHERSOME
NO SYMPTOMS? YES

NOCTURNAL POLYURIA
NO PREDOMINANT YES

STORAGE SYMPTOMS
NO PREDOMINANT YES

PROSTATE
NO VOLUME >40 ML YES

EDUCATION + LIFESTYLE
ADVICE
ALPHA 1 BLOCKER
(TAMSULOSIN, TERAZOSIN,
DOXAZOSIN)

ADD MUSCARINIC EDUCATION + LIFESTYLE ADVICE EDUCATION + LIFESTYLE ADVICE EDUCATION +

WATCHFUL WAITING RECEPTOR 5-ALPHA REDUCTASE INHIBITOR WITH OR WITHOUT MUSCARINIC LIFESTYLE ADVICE
WITH OR WITHOUT ANTAGONIST (FINASTERIDE, DUTASTERIDE) RECEPTOR ANTAGNONIST WITH OR WITHOUT
EDUCATION + LIFESTYLE (TOLTERODINE)/BETA- PLUS (TOLTERODINE)/BETA-3 AGONIST VASOPRESSIN
ADVICE 3 AGONIST ALPHA-1 BLOCKER (MIRABEGRON) ANALOGUE
(MIRABEGRON) (TAMSULOSIN, TERAZOSIN, DOXAZOSIN)

COMBINATION DRUGS AVAILABLE IN THE

PHILIPPINES: dutasteride+tamsulosin
(DUODART)

FOLLOW UP IN 3-6 MONTHS

LIFESTYLE MODIFICATION
 Fluid restriction particularly at bedtime
 Avoidance of caffeinateddrinks and spicy foods
 Timed or organized voiding (Bladder training)
 Pelvic floor exercises
 Avoidance or treatment of constipation
European Association of Urology of 2022 Guidelines on Management of Non-
Neurogenic Male Lower Urinary Tract Symptoms (LUTS)
 Male LUTS
WITH ABSOLUTE INDICATIONS FOR SURGERY OR NON-RESPONDERS TO MEDICAL TREATMENT OR
THOSE WHO DO NOT WANT MEDICAL TREATMENT BUT REQUIRES ACTIVE TREATMENT

NO HIGH- RISK PATIENTS? YES

CAN HAVE SURGERY

YES NO
UNDER ANESTHESIA?

CAN STOP
YES ANTICOAGULATION/ANTIPLATELET NO
THERAPY

PROSTATE
<30 ML > 80 ML
VOLUME

30-80 ML

TURP

LASER OPEN PROSTATECTOMY LASER VAPORISATION BLADDER

ENUCLEATION BIPOLAR ENUCLEATION LASER ENUCLEATION CATHETERIZATION
TURP LASER LASER VAPORISATION
VAPORISATION TURP

ABSOLUTE INDICATIONS FOR SURGERY

Patients who have:

 Renal insufficiency
 Refractory urinary retention secondary
 Recurrent urinary tract infections
 Recurrent urinary bladder stones or gross
hematuria

European Association of Urology of 2022 Guidelines on Management of Non-

Neurogenic Male Lower Urinary Tract Symptoms (LUTS)
INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS)