Lower Urinary Tract Symptoms – Males

  • Is common and increases in incidence as men increase in age
  • Has a wide variety of causes. In men, the most common causes would include:
    • Lifestyle factors: caffeine & alcohol intake, smoking, obesity
    • Enlarged prostate: happens naturally and commonly as men get older
    • Overactive (or even under-active) bladder
    • Urine infection
    • Narrowing (stricture) of the urethra
    • Neurological disorders
      • History of stroke, parkinsons disease, other
    • Underlying bladder pathology
    • Other
Lower Urinary Tract Symptoms – Males
What Are Some Common Symptoms?
  • Symptoms are usually divided into voiding and storage symptoms
    • Voiding: hesitancy (slow to initiate urination), slow stream, intermittent stream of urine, end dribbling, straining to void, incomplete emptying
    • Storage: urinary frequency, urgency (the need to rush to the toilet with minimal warning), urge associated incontinence
  • Many men will have a mixture of both

These are often referred to as LUTS – Lower Urinary Tract Symptoms

How Might My Urologist Assess My Symptoms?
  • History: apart from a general medical and surgical history, your Urologist will focus their questioning on the following issues
    • Urological history
    • Lifestyle
      • Fluid intake: volume and type (specifically, coffee, tea & alcohol)
      • Smoking
      • Blood in urine
    • Most bothersome lower urinary tract symptoms
  • Examination
    • abdominal examination
    • prostate examination (digital rectal exam)
    • occasionally a lower limb neurological examination is required
  • Investigations
    • Symptom score – IPSS (International Prostate Symptom Score)
    • Bladder diary
    • Uroflow
      • A test to quantify the speed at which the urine comes out
    • Urine test: to exclude an infection and check for microscopic blood
    • Blood test: in particular a kidney function check and a PSA test
  • Imaging
    • Ultrasound
      • Post void residual – volume of urine left in the bladder after voiding
      • Prostate volume
    • CT – occasionally required if there is suspicion of an anatomical abnormality or other suspected pathology such as a stone or a growth in the urinary tract
    • MRI
      • Of the brain and spinal cord: rarely required, only if a neurological cause for your bladder symptoms are suspected
  • Sub-specialised tests
    • Urodynamics
    • Transperineal ultrasound
  • Procedure
    • Cystoscopy – an internal camera inspection of the urethra and bladder
What Are My Treatment Options?

How your LUTS will be treated ultimately depends on the underlying cause.

The treatment plan may be simple or a little more complex: your Urologist will guide you through this.

Treatment typically involves a step-wise progression starting at life style measures, medications, minimally invasive procedures and finally more complex procedures. Some of the treatment options are outlined below (some may not be relevant to yourself):

  • Lifestyle measures
    • Reduction in caffeinated drinks and alcohol
    • Quit smoking
    • Weight loss
    • Reduction of evening fluid intake if excessive night time voiding is a problem
  • Medication
    • If your symptoms are largely voiding symptoms, medications that may be helpful include
      • Tamsulosin
      • Duodart
    • If your symptoms are largely storage symptoms, medications that may be helpful include
      • Mirabegron
      • Solifenacin
      • Oxybutynin
    • Surgical
      • If the symptoms are due to an enlarged prostate, a TURP (transurethral resection of prostate) may be what you will require
        • Please see ‘enlarged prostate’ for more information regarding this
      • If the symptoms are due to an over-active bladder you may progress onto one of the following:
        • Botox – injected into the bladder wall
        • Sacral Neuromodulation
        • Other (rare): cystoplasty, urinary diversion
      • Non-surgical
        • Catheter
          • clean intermittent self catheterization
          • long term catheter: urethral or suprapubic
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