Lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) are a common problem affecting approximately 40% of older men.^[1] LUTS is a recent term for what used to be known as prostatism.^[2]

Contents 1 Symptoms and signs 1.1 Filling or irritative symptoms 1.2 Voiding or obstructive symptoms 2 Epidemiology 3 Assessment 4 Possible causes of the lower urinary tract symptoms 5 Treatment 6 Use of the term LUTS in diagnosis codes of ICD 9 CM 7 References

Symptoms and signs

Symptoms can be categorised into:

Filling or irritative symptoms

• Frequency
• Urgency
• Dysuria
• Nocturia
• odynuria

Voiding or obstructive symptoms

• Poor stream
• Hesitancy
• Terminal dribbling
• Incomplete voiding
• Overflow incontinence (occurs in chronic retention)

As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.^[3] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.^[4]

Epidemiology

• Prevalence increases with age. The prevalence of nocturia in older men is about 78%. Older men have a higher incidence of LUTS than older women.^[5]

• Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.^[6]

• Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.

• It is estimated that the lifetime risk of developing microscopic prostate cancer is about 30%, developing clinical disease 10%, and dying from prostate cancer 3%.

Assessment

The International Prostate Symptom Score (IPSS) can be used to gauge the symptoms, along with physician examination. Other primary and secondary tests are often carried out, such as a PSA (Prostate-specific antigen) test,^[7] urinalysis, ultrasound, urinary flow studies, imaging, temporary prostatic stent placement, prostate biopsy and/or cystoscopy.

Placement of a temporary prostatic stent as a differential diagnosis test can help identify whether LUTS symptoms are directly related to obstruction of the prostate or to other factors worth investigation.

Possible causes of the lower urinary tract symptoms

• Benign prostatic hyperplasia (BPH) with obstruction
• Detrusor muscle weakness and/or instability
• Urinary Tract Infection (UTI)
• Chronic prostatitis
• Urinary stone
• Malignancy: prostate or bladder
• Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome

Treatment

A number of techniques to destroy part or all of the prostate have been developed.

Techniques include:

• Transurethral microwave thermotherapy
• Thermal ablation
• High intensity focused ultrasonography
• Transurethral needle ablation
• Laser prostatectomy.
• Intraurethral prostatic stenting and balloon dilatation of the prostate.^[8]

Other treatments include lifestyle advice and alpha blocker therapy. Although surgical treatment is generally reserved for men who have failed or are unable to tolerate drug treatment, or for those who have developed complications

Use of the term LUTS in diagnosis codes of ICD 9 CM

• 600.00 Hypertrophy (benign) of prostate w/o urinary obstruction and other lower urinary tract symptoms (LUTS)
• 600.01 Hypertrophy (benign) of prostate with urinary obstruction and other LUTS
• 600.20 Benign localized hyperplasia of prostate w/o urinary obstruction and other LUTS
• 600.21 Benign localized hyperplasia of prostate with urinary obstruction and other LUTS
• 600.90 Hyperplasia of prostate, unspecified, w/o urinary obstruction and other LUTS
• 600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other LUTS

References

• British Association of Urological Surgeons; Primary care management of male lower urinary tract symptoms (LUTS). February 2004
• European Association of Urology Guideline; Benign Prostatic Hypertrophy (2004)
• NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.