RAG rating
n/a
Document type
Clinical pathways
Place
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Pathway
LUTS Pathway

Male LUTS

Pathway published: June 2024.
Next review date: June 2026.
 
 Lower urinary tract symptoms (LUTS) can be grouped into storage, voiding, and post-micturition symptoms.
    • Storage symptoms include urgency, daytime urinary frequency, nocturia, and urinary incontinence. 
    • Voiding symptoms include slow stream, splitting or spraying, straining, intermittency, hesitancy, straining, and terminal dribbling. 
    • Post-micturition symptoms include post-micturition dribble and the sensation of incomplete emptying. 

  • Lower urinary tract symptoms (LUTS) in men can be caused by:
    • Structural or functional abnormalities in one or more parts of the lower urinary tract (the bladder, bladder neck, prostate, urethral sphincter, and urethra).
    • Abnormalities of the peripheral or central nervous system that affect control of the bladder and sphincter.
    • Cardiovascular, respiratory, renal, or endocrine conditions that affect the production of urine.

  • Most elderly men have at least one LUTS; however, symptoms are often mild or not very bothersome.
  • Benign prostatic enlargement is a common cause of LUTS. Other causes include neurological conditions (such as dementia and diabetic neuropathy), infection, injury to the urethral area, drugs (such as diuretics and antimuscarinics), and cancer.

  • An assessment of men with suspected LUTS should include:
    • Taking a history of symptoms and severity, asking about possible underlying causes, sexual function, lifestyle habits, emotional and psychological factors.
    • Reviewing current medication.
    • Offering a physical examination, and examining the abdomen, external genitalia, performing a digital rectal examination, and examining the perineum and/or lower limbs. 
    • Asking men with bothersome LUTS to complete a urinary frequency-volume chart for at least 3 days.
    • Excluding serious causes of LUTS.  

  • Investigations should be guided by the symptoms, history, and examination but may include:
    • 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.
    • A prostate-specific antigen (PSA) test if appropriate.

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

  • Management of LUTS includes:
    • Excluding (and managing) serious causes of LUTS.
    • Providing tailored information and advice. 
    • Offering drug treatment to men with bothersome LUTS if conservative management is unsuccessful or inappropriate. 
      • An alpha-blocker for men with moderate to severe LUTS.
      • A 5-alpha reductase inhibitor for men with LUTS who have prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml, and who are considered to be at high risk of progression.
      • An antimuscarinic for men with symptoms of overactive bladder or mirabegron if an antimuscarinic is contraindicated, not effective, or not tolerated.
      • A loop diuretic or oral desmopressin for men with nocturnal polyuria.
      • Combination treatments where appropriate. 
    • Regularly reviewing treatment to re-assess symptoms, quality of life, and assess adverse effects.   
    • Arranging specialist referral if appropriate. 
 

 
Please see pathway attached. 
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