LOWER URINARY TRACT

SYMPTOMS:
ASSESSMENT AND TREATMENT
R BABALOLA
SPECIALTY DOCTOR, UROLOGY
 OUTLINE
• Introduction
• Anatomy
• Causes
• Assessment
• Treatment
• Conclusion
 INTRODUCTION
• Quite common in middle-aged/elderly men
• Prevalence increases with age – 3% in men 40-44 years, and >30% in men >65 years
(NICE)
• Has significant impact on men’s quality of life and can also be an early
signal to significant underlying disease
• Involve voiding, storage and post-micturition symptoms
LOWER URINARY
TRACT ANATOMY
 LUTS
• Storage • Voiding
• Daytime frequency • Hesitancy
• Urgency • Weak stream
• Nocturia
• Intermittent urinary stream
• Urge incontinence
• Splitting/splaying stream
• Post micturition • Incomplete emptying
• Dribble
• Terminal dribbling
• Sense of incomplete emptying
 LUTS: CAUSES

BPE
OAB
Prostate cancer
Urethral stricture

EAU Guidelines,
2021
 ASSESSMENT
• History
• Physical examination
• Laboratory testing and uroflowmetry
• Imaging and urethrocystoscopy
• History • Symptoms (voiding, storage, post-
• Physical examination mic)
• Laboratory testing and • IPSS
uroflowmetry • Haematuria; ??infection (dysuria, fever)
• Imaging and urethrocystoscopy • Relevant co-morbidities
• Medications
• Lifestyle
 ASSESSMENT
• History • General physical exam
• Physical examination • Abdominal exam
• Laboratory testing and • External genitalia
uroflowmetry • DRE
• Enlarged prostate
• Imaging and
urethrocystoscopy
• History
• Physical examination
• Laboratory testing and
uroflowmetry
• Imaging and urethrocystoscopy
• History
• Physical examination
• Laboratory testing and
uroflowmetry
• Imaging and
urethrocystoscopy
TREATMENT
 TREATMENT:OVERVIEW
• General and specific Rx
• Depends on cause, severity,
comorbidities
• Lifestyle
• Medications
• α-blockers; anti-muscarinics,
mirabegron
• 5 α-reductase inhibitors
• Surgical intervention
• Prostate
• TURP/TUIP/Urolift
• Laser/open prostatectomy
• Urethra
• Optical urethrotomy
• OAB – Botox, Cystoplasty
• FOLLOW-UP
 HISTORY
Hesitancy, poor flow, straining, intermittency, terminal dribbling
Frequency, urgency, nocturia, urge incontinence
Haematuria, back pain, lower limb weakness
Past medical history
Medications

EXAMINATION
• General physical examination
• Abdominal examination
• External genitalia – meatal stenosis, urethral stricture
• Rectal examination - prostate
 INVESTIGATIONS TREATMENT
Urine flow rate and post void residual Lifestyle
Urinalysis Medications
Bloods including PSA Surgery
 CONCLUSION
• LUTS is a very common urological complaint in middle-aged and elderly
men
• Proper assessment is crucial
• Management depends on the cause
• Regular re-assessment and follow-up is needed
THANK YOU
 References
• BJUI Knowledge – LUTS
• EAU Guidelines 2021 – Non-neurogenic Male LUTS
• NICE Guidance LUTS – last update June 2015