Lower urinary tract symptoms
Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms, that affect approximately 40% of older men.[1] LUTS is a recent term for what used to be known as prostatism.[2]
Symptoms and signs
Symptoms can be categorised into:
Filling (Storage) or irritative symptoms
- Increased frequency of urination
- Increased urgency of urination
- Painful urination
- Excessive passage of urine at night
Voiding or obstructive symptoms
- Poor stream (unimproved by straining)[3]
- Hesitancy (worsened if bladder is very full)[3]
- Terminal dribbling
- Incomplete voiding
- Overflow incontinence (occurs in chronic retention)[3]
- Episodes of near retention[3]
As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.[2] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[4]
Causes
- Benign prostatic hyperplasia (BPH) with obstruction
- Detrusor muscle weakness and/or instability
- Urinary Tract Infection (UTI)
- Chronic prostatitis
- Urethral stricture
- Urinary stone
- Malignancy: prostate or bladder
- Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome
- IgG4-related prostatitis[5][6][7]
Diagnosis
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,[8] 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.
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
Treatment
A number of techniques to destroy part or all of the prostate have been developed. First line of treatment is medical, which includes alpha-1 blockade and antiandrogens. If the medical treatment fails, surgical techniques are done. Techniques include:
- TURP: trans-urethral removal of the prostate
- Transurethral microwave thermotherapy
- Thermal ablation
- High intensity focused ultrasonography
- Transurethral needle ablation
- Laser prostatectomy.
- Intraurethral prostatic stenting and balloon dilatation of the prostate.[9]
Voiding position
Other treatments include lifestyle advice,[10] for example sitting down while urinating. A meta-analysis[11] found that, for elderly males with LUTS:
- the post void residual volume (PVR, ml) was significantly decreased
- the maximum urinary flow (Qmax, ml/s) was increased, comparable with pharmacological intervention
- the voiding time (VT, s) was decreased
This urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.
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.[12]
- Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[13]
- 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%.
References
- Speakman MJ, Kirby RS, Joyce A, Abrams P, Pocock R (May 2004). "Guideline for the primary care management of male lower urinary tract symptoms". BJU Int. 93 (7): 985–90. doi:10.1111/j.1464-410X.2004.04765.x. PMID 15142148.
- Juliao AA, Plata M, Kazzazi A, Bostanci Y, Djavan B (January 2012). "American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited". Current Opinion in Urology 22 (1): 34–9. doi:10.1097/MOU.0b013e32834d8e87. PMID 22123290.
- NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
- ↑ RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell's Urology. WB Saunders Co 2002; chapt 38, p1309.
- 1 2 Abrams P (April 1994). "New words for old: lower urinary tract symptoms for "prostatism"". BMJ 308 (6934): 929–30. doi:10.1136/bmj.308.6934.929. PMC 2539789. PMID 8173393.
- 1 2 3 4 Masu S (May 2014). "A Prevalence Study of Lower Urinary Tract Symptoms (LUTS) in Males" (PDF). International Journal of Medical Science and Public Health 3 (8): 927–30. doi:10.5455/ijmsph.2014.020520142.
- ↑ Clinical Knowledge Summary; Urological cancer — suspected
- ↑ Rodolfo Montironi, Marina Scarpelli, Liang Cheng, Antonio Lopez-Beltran, Maurizio Burattini, Ziya Kirkali, Francesco Montorsi (December 2013). "Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer". European Urology 64 (1): 865–872. doi:10.1016/j.eururo.2012.11.056. PMID 23266239.
- ↑ Yoshimura Y, Takeda S, Ieki Y, Takazakura E, Koizumi H, Takagawa K (1 Sep 2006). "IgG4-associated prostatitis complicating autoimmune pancreatitis". Internal Medicine (Japanese Society of Internal Medicine) 45 (15): 897–901. doi:10.2169/internalmedicine.45.17522. PMID 16946571.
- ↑ Nishimori I, Kohsaki T, Onishi S, Shuin T, Kohsaki S, Ogawa Y, Matsumoto M, Hiroi M, Hamano H, Kawa S (17 Dec 2007). "IgG4-related autoimmune prostatitis: two cases with or without autoimmune pancreatitis". Internal Medicine (Japanese Society of Internal Medicine) 46 (24): 1983–1989. doi:10.2169/internalmedicine.46.0452. PMID 18084121.
- ↑ The Prostate-Specific Antigen (PSA) Test: Q & A — National Cancer Institute
- ↑ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
- ↑ Y. de Jong, R.M. ten Brinck, J.H.F.M. Pinckaers, A.A.B. Lycklama à Nijeholt. "Influence of voiding posture on urodynamic parameters in men: a literature review" (PDF). Nederlands Tijdschrift voor urologie. Retrieved 2014-07-02.
- ↑ de Jong, Y; Pinckaers, JH; Ten Brinck, RM; Lycklama À Nijeholt, AA; Dekkers, OM (2014). "Urinating Standing versus Sitting: Position Is of Influence in Men with Prostate Enlargement. A Systematic Review and Meta-Analysis.". PLOS ONE 9 (7): e101320. doi:10.1371/journal.pone.0101320. PMC 4106761. PMID 25051345.
- ↑ Boyle P, Robertson C, Mazzetta C, et al. (September 2003). "The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study". BJU Int. 92 (4): 409–14. doi:10.1046/j.1464-410x.2003.04369.x. PMID 12930430.
- ↑ Enlarged prostate gland —treatment, symptoms and cause
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