Lower Urinary Tract Symptoms in Men

Examination

  • Examination of the abdomen for signs of a distended bladder, such as abdominal distention and suprapubic dullness on percussion.

  • A check of the external genitalia to identify conditions which may cause or contribute to LUTS, for example phimosis, meatal stenosis, or penile cancer.

  • A digital rectal examination to assess the prostate for size, consistency, nodules, and tenderness.

  • Examination of the perineum and/or lower limbs to evaluate motor and sensory function.

Investigations

  • A dipstick test of the urine to check for blood, glucose, protein, leucocytes, and nitrites.

  • Serum creatinine and estimated glomerular filtration rate (eGFR) should be measured if clinically indicated.

  • Prostate specific antigen (PSA) testing should be done only after discussing the indications for the test and the interpretation and implications of the results, and considering with the man whether an abnormal result would affect further management choices. The man should be given sufficient time to decide if he wishes to have the test.

Men with bothersome LUTS should be advised to complete a urinary frequency-volume chart to distinguish between
urinary frequency, polyuria, nocturia, and nocturnal polyuria.

Men considering any treatment for LUTS should be offered an
assessment of their baseline symptoms
validated symptom score, such as the International Prostate Symptom Score (IPSS),
to allow assessment of subsequent symptom change

Storage symptoms

urgency
daytime urinary frequency
nocturia
urinary incontinence
feeling the need to urinate again just after passing urine
bedwetting- sign of chronic urinary retention
supervised bladder training
1st anticholinergic (Oxybutynin (IR), tolterodine IR)
2nd mirabegron 
3rd Botulinum into bladder wall

 

Voiding symptoms
hesitancy
weak or intermittent urinary stream sometimes causing splitting or spraying
straining
incomplete emptying
terminal dribbling.
pelvic floor muscle training
fluid intake control
1st. Tamsulosin (alpha blocker)
2nd (5alpha reductase inhibitor) Dutasteride/Finasteride if prostate enlarged
3rd 1st +2nd

if mixed picture of storage and voiding symptoms
Add on anticholinergic (tolterodine)

 

Post-micturition symptoms
post-micturition dribble
sensation of incomplete emptying.
urethral milking

Nocturnal polyuria
limit fluid intake
late afternoon 40mg furosemide

stress urinary incontinence
supervised pelvic floor muscle training.

Urinary retention
Catheterise
alpha blocker alfuzosin MR 10mg od (max 4 day use, includes 1d after TWOC)

 
Dr Rajesh VarmaLUTS in men