Lower urinary tract symptoms

Key facts:
- Important to determine who much the symptoms are bothering the patient as treatment will be determined by that.

• Examination:
• abdominal examination: looking for a distended bladder
• DRE: looking for an abnormal prostate e.g. hard, nodular, asymmetry
• examination of the penis, checking for a tight phimosis or narrow meatus
• neurological examination of the perineum and lower limbs: looking for neurological condition that could cause a neurogenic bladder
• Investigations
• Urinalysis and urine MCS
• Fasting glucose to exclude diabetes
• UEC 
• PSA after discussing with patient 
• Urinary tract ultrasound 
• other investigations: bladder diary, urinary flow rate and urodynamic study 
• Differential diagnoses of LUTS
• Lower urinary tract obstruction 
• overactive bladder
• bladder irritation 
• polyuria
• neurological causes 
• Treatment option s
• conservative management for patients with mild symptoms 
• Medical therapy 
• alpha blockers: tamsulosin and prazosin. Tamsulosin is better as it has less side effects, doesn't cause erected dysfunction and acts quickly in few days
• 5 aplha reductase inhibitors: finesteride or dustasteride. slow onset (months) and may cause sexual dysfunction
• combination therapy: tamsulosin/dutasteride
• anticholinergics: best avoid 
• Surgical therapy
• TURP 
• Laser ablation, transurethral needle ablation (TUNA), thermotherapy or open operation

Reference:

- Check program 2012 October