Lower Urinary Tract Symptoms (LUTS)

Basuki B.Purnomo, Besut Daryanto

Medical School Brawijaya University
Dr Saiful Anwar General Hospital
MALANG
Vesico-urethral Unit
 Lower urinary tract normal function

• Bladder filling or storage phase

• Urine store with low bladder pressure with no
unpleasent sensation
• Bladder outlet closed until need to void
• Bladder emptying or voiding phase
• Bladder detrussor muscle contract
• Bladder outlet relax
 Bladder Control System
bladder muscle bladder muscle

bladder bladder
urine urine

Urethra closed Urethra open

Sphincter Muscles Squeezed Sphincter Muscles Relaxed

 1. Bladder fills
Detrusor muscle relaxes

Urination Urethral sphincter

contracts
2. First desire to urinate
(bladder half full)

Bladder Filling
& Emptying
Detrusor muscle Urethral sphincter
Cycle
contracts relaxes

3. Urination
voluntarily inhibited until time
and place are right
Normal Control of Urination
 Etiology?
Bladder factor:
Bladder • Neurogenic
• Inflamation
• Stone..etc

Seminal Vesicle
Prostate
BPH Urethral factor:
• BPH/Prostate Ca,
constricting • Urethra stricture,
the urethra Urethra
• Stone
• Phymosis...etc

Image source: Virginia Urology Center

Neurologic control of
micturation process
 Normal Vs Abnormal Voiding
Frequency Voiding
Urgency
Nocturia sensation
Satisfied
voiding

Incomplete Beginnin
emptying g voiding Hesitancy

Stop voiding
after bladder
empty
Decrease calibre
Post voiding Good flow & & force
caliber
dribbling Uninterrupted Intermittency
Painless
Dysuria
 International Prostate Symptom Score (IPSS)
Not at Less than 1 Less than About More Almost Your
half the half the than half
all time in 5 time time the time always score

Incomplete emptying
Over the past month, how often have you had a sensation of not emptying your 0 1 2 3 4 5
bladder completely after you finish urinating?

Frequency
Over the past month, how often have you had to urinate again less than two hours 0 1 2 3 4 5
after you finished urinating?

Intermittency
Over the past month, how often have you found you stopped and started again several 0 1 2 3 4 5
times when you urinated?

Urgency
Over the last month, how difficult have you found it to postpone urination? 0 1 2 3 4 5
Weak stream
Over the past month, how often have you had a weak urinary stream? 0 1 2 3 4 5
Straining
Over the past month, how often have you had to push or strain to begin urination? 0 1 2 3 4 5

None 1 time 2 times 3 times 4 times 5 times Your

or more score
Nocturia
Over the past month, many times did you most typically get up to urinate from the 0 1 2 3 4 5
time you went to bed until the time you got up in the morning?

Total IPSS score

Mostly Mixed – about Mostly

Quality of life due to urinary symptoms Delighted Pleased satisfied
equally satisfied
dissatisfied Unhappy Terrible
and dissatisfied

If you were to spend the rest of your life with your urinary condition the way
it is now, how would you feel about that? 0 1 2 3 4 5 6

Total score: 0-7 Mildly symptomati c; 8-19 moderately symptomati c; 20-35 severely symptomati c.
 Urgency
A strong and sudden desire to urinate
Hesitancy
Dribbling
 Frequency
Going to the toilet often (more than
eight times in a 24-hour period)
Nocturia (nycturia)
Overflow of incontinence
Pathophysiology Urinary Tract Obstruction (“Symptoms”)

Structure Alteration Symptoms of Urinary tract Abnormality

• Infection (pyonephrosis): fever, pyuria

• Renal failure: oliguria, anuria, acidosis,
weakness, pale.

Loin pain

• LUTS consist of storage and

voiding problems
• Acute urinary retention
• Hematuria
Diagnosis & Detection of Complication
• Systematic history taking
• Physical examination
• Laboratory & Imaging study
• Urodynamic study or cystoscopy and studies
as needs
• Voiding diary
 History taking & Physical Examination

• Skill development
• Include: IPSS or AUA score, & Quality of Life
(QoL)
UROFLOWMETRY

Male 70 years old with LUTS

Cystocopic view of BPH