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Lower Urinary Tract Symptoms (LUTS)1

What are Lower Urinary Tract Symptoms (LUTS)?

Lower urinary tract symptoms or LUTS are symptoms connected to issues with the lower urinary tract organs, such as the urethra, bladder, and prostate. LUTS are widely categorized into symptoms involving the passing or storage of urine. An affected individual might have symptoms related to one or the other, or a combination of both.

Lower urinary tract symptoms are mostly the result of bladder outlet obstruction associated with prostate enlargement, also known as BPH or benign prostatic hyperplasia, that affects nearly all men by the age of 80.

Causes of Lower Urinary Tract Symptoms (LUTS)

Some of the common causes of lower urinary tract symptoms may include:

  • Urinary tract infection
  • Prostatitis (inflammation of the prostate gland)
  • Enlargement of the prostate gland
  • Overactive bladder
  • Urethral stricture
  • Bladder neck hypertrophy
  • Bladder outlet obstruction
  • Diabetes
  • Obesity
  • High blood pressure
  • Obstructive sleep apnea
  • Smoking
  • Certain medications
  • Erectile dysfunction
  • Low levels of physical activity
  • Excessive alcohol or caffeine

Symptoms of Lower Urinary Tract Symptoms (LUTS)

Some of the common symptoms of lower urinary tract symptoms include:

  • Urgency – the need to pass urine without any warning
  • Frequency – the need to pass urine frequently
  • Hesitancy – unable to pass urine immediately
  • Weak stream – decrease in the force of urine flow
  • Nocturia – the need to pass urine often at night
  • Dribbling – leakage of urine after urination has finished
  • Urge incontinence – intense and sudden need to urinate without control leading to leakage
  • Stress incontinence – leakage of urine due to stress while coughing, sneezing, or physical activity

Diagnosis of Lower Urinary Tract Symptoms (LUTS)

Your doctor will confirm whether or not you have lower urinary tract symptoms based on your symptoms, medical history, and examination; however, you will need additional diagnostic tests to work out the cause. Some of the diagnostic processes involved in diagnosing LUTS may include:

  • Cystoscopy to diagnose prostatic obstruction or urethral stricture by use of a cystoscope (a flexible, lighted instrument inserted into your urethra)
  • Pressure flow study, cystometry, and urethral sphincter electromyography to measure sphincter activity and detrusor (smooth muscle of the bladder wall) function
  • Bulbocavernosus reflex test to assess neurogenic bladder
  • Postvoid residual volume test to check if you can empty the bladder completely
  • Digital rectal exam to check for prostate enlargement
  • Urine test to look for infection or other conditions that can cause symptoms of LUTS
  • Prostate-specific antigen (PSA) blood test to look for elevated PSA levels that indicates enlarged prostate
  • Urinary flow test to measure the strength and amount of urine flow
  • Urodynamic and pressure flow studies to assess how well your bladder muscles are functioning

Treatment for Lower Urinary Tract Symptoms (LUTS)

Treatment for lower urinary tract symptoms involves both non-surgical as well as surgical options. The primary objective of treatment is to reduce LUTS, enhance prostate-related quality of life, and delay or avert disease progression.

Non-Surgical Treatment

  • Alpha blockers: Based on The American Urological Association (AUA) guideline on the management of BPH, use of alpha blocker medications such as doxazosin, alfuzosin, terazosin, and tamsulosin have been regarded as appropriate and effective treatment options for men with troublesome BPH/LUTS.
  • 5-alpha reductase inhibitors: 5-ARI agents, such as dutasteride and finasteride is another option for BPH/LUTS and BPE (benign prostatic enlargement) and are regarded as far better than alpha blockers in preventing disease progression.
  • Combination drug therapy: Use of alpha blocker and a 5-alpha reductase inhibitor at the same time may be necessary if either medication alone is found to be ineffective.

Surgical Treatment

As LUTS are mostly associated with prostate enlargement, surgical options are also concerned with the treatment of prostate enlargement and include:

  • TUIP or transurethral incision of the prostate: In this procedure, your surgeon makes one or two small surgical cuts in the prostate gland with the aid of a flexible lighted scope with a camera inserted into the urethra to make passage of urine through the urethra easier. This surgery is employed if you have a small or moderately enlarged prostate gland.
  • TURP or transurethral resection of the prostate: In this procedure, your surgeon removes all except the outer section of the prostate with the aid of a flexible lighted instrument with a camera called a resectoscope that is passed into the end of the penis through the urethra. The resectoscope also consists of an electrical loop that cuts tissue and seals blood vessels.
  • TUMT or transurethral microwave thermotherapy: In this procedure, your doctor inserts a special electrode via the urethra into the prostate area. Microwave energy from the electrode destroys the inner section of the enlarged prostate gland, shrinking it and relaxing urine flow.
  • Laser therapy: A high-energy laser removes or destroys overgrown prostate tissue. Laser therapy usually mitigates symptoms right away and has a reduced risk of side effects compared to non-laser surgery.
  • PUL or prostatic urethral lift: In this procedure, special tags are employed to compress the sides of the prostate to enhance the flow of urine. The procedure is the first choice of treatment for people with lower urinary tract symptoms who are concerned about side effects affecting ejaculation and sexual function.
  • Open or robot-assisted prostatectomy: In this procedure, your surgeon makes a surgical cut in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is usually performed if you have a very large prostate, bladder damage or other complicating factors.