Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men[1] – over 40% of older men are affected[2][3][4][5] – but lower urinary tract symptoms also affect women.[6] The condition is also termed prostatism in men, but LUTS is preferred.[7]
As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.[7] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[11] Also, recently a report of lower urinary tract symptoms even with malignant features in the prostate failed to be associated with prostate cancer after further laboratory investigation of the biopsy.[10]
Treatment will depend on the cause, if one is found. For example; with a UTI, a course of antibiotics would be given[medical citation needed]; appropriate medication would be administered to treat benign prostatic hyperplasia.
Lifestyle changes
Other treatments include lifestyle advice; for example, avoiding dehydration in recurrent cystitis.[citation needed]
Men with prostatic hypertrophy are advised to sit down whilst urinating.[18] A 2014 meta-analysis found that, for elderly males with LUTS, sitting to urinate meant there was a decrease in post-void residual volume (PVR, ml), increased maximum urinary flow (Qmax, ml/s), which is comparable with pharmacological intervention, and decreased the voiding time (VT, s).[19] The improved urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.[19]
Physical activity
Physical activity has been recommended as a treatment for urinary tract symptoms. A 2019 Cochrane review of six studies involving 652 men assessing the effects of physical activity alone, physical activity as a part of a self-management program, among others.[20] The evidence from this review states that there are important uncertainties whether physical activity is helpful in men experiencing urinary symptoms caused by benign prostatic hyperplasia.[20]
Medications
With benign prostatic enlargement causes of LUTS, people may be offered a variety of medications (as a single drug or combining them) when there are persistent moderate symptoms:[21]
If medical treatment fails, or is not an option; a number of surgical techniques to destroy part or all of the prostate have been developed.[citation needed]
Surgical treatment
Surgical treatment of LUTS can include:
Ablation procedures – used in treating both bladder tumours[22] and bladder outlet obstruction, such as prostate conditions.[23]
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.[25]
Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[26]
Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.[citation needed]
^Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Burattini M, Kirkali Z, Montorsi F (December 2013). "Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer". European Urology. 64 (6): 865–872. doi:10.1016/j.eururo.2012.11.056. PMID23266239.
^Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, et al. (April 2015). "Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014". World Journal of Urology. 33 (4): 571–579. doi:10.1007/s00345-014-1337-y. PMID24935098. S2CID8976911.
^Elshal AM, Elmansy HM, Elhilali MM (March 2013). "Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes". Urology. 81 (3): 634–639. doi:10.1016/j.urology.2012.11.042. PMID23332997.
^Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
^Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, et al. (September 2003). "The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study". BJU International. 92 (4): 409–414. doi:10.1046/j.1464-410x.2003.04369.x. PMID12930430. S2CID7709214.
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 International. 93 (7): 985–990. doi:10.1111/j.1464-410X.2004.04765.x. PMID15142148.
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): 34–39. doi:10.1097/MOU.0b013e32834d8e87. PMID22123290. S2CID41964732.
NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
