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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]

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.

^ RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell's Urology. WB Saunders Co 2002; chapt 38, p1309.
^ New words for old: lower urinary tract symptoms for "prostatism" - Abrams 308 (6934): 929 - BMJ
^ Abrams P; New words for old: lower urinary tract symptoms for "prostatism". BMJ. 1994 Apr 9;):929-30.
^ Clinical Knowledge Summary; Urological cancer - suspected
^ Boyle P, Robertson C, Mazzetta C, et al.; The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003 Sep;92(4):409-14. [abstract]
^ Enlarged prostate gland - treatment, symptoms and cause
^ The Prostate-Specific Antigen (PSA) Test: Q & A - National Cancer Institute
^ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.

UpToDate Contents

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1. 男性における下部尿路症状 lower urinary tract symptoms in men
2. 前立腺肥大症の内科的治療 medical treatment of benign prostatic hyperplasia
3. 前立腺肥大症の臨床症状および診断 clinical manifestations and diagnosis of benign prostatic hyperplasia
4. 男性の尿失禁 urinary incontinence in men
5. 良性前立腺肥大症の外科的治療およびその他の侵襲的治療 surgical and other invasive therapies of benign prostatic hyperplasia

Japanese Journal

前立腺肥大症患者に対するシロドシンの初回至適投与量・投与方法の検討

和田直樹,沼田篤,山口聡,小山内裕昭,森達也,芳生旭辰,藤澤真,金子茂男,柿崎秀宏
泌尿器科紀要 57(6), 297-302, 2011-06
… We investigated the optimum initial dose and timing of administration of α1A-adrenoceptor antagonist silodosin for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS). … In conclusion, 4 mg of silodosin daily showed effectiveness against BPH/LUTS, but 8 mg of silodosin daily might be better for patients with severe LUTS. …
NAID 120003221325