What are lower urinary tract symptoms (LUTS)?

LUTS (lower urinary tract symptoms) refers to the conditions that define a wide range of symptoms or issues of the lower urinary tract that comprises of bladder, urethra and prostate gland. LUTS are widely categorized into voiding or obstructive symptoms or storage also called irritative symptoms. A person may have voiding symptoms, or storage symptoms, or a combination of both.

Obstructing Symptoms or Voiding                                            Storage or Irritative Symptoms

Poorly directed and weak stream of urine                               An urgent need to urinate

Strain while urinating                                                                   A shorter time between urination

Irregular stream or dribbling even after                                    Incontinence- that is followed by an finishing urination                                                                         uncontrolled  flow of urine after an intense urge to pee

Chronic urinary retention

Difficulty in starting Urination

Overflow or paradoxical incontinence – urine overflows from a full bladder uncontrollably even though normal urination can be difficult to start

How common are LUTS?

LUTS are very common amongst the ageing male population. These symptoms have notable effects on quality of life in aged men. About 30% of men between the age of 50 and older have LUTS ranging from moderate to severe. This is a very large group potentially requiring treatment. Although LUTS do not usually cause severe illness, they can considerably reduce patient’s quality of life and that may point towards severe pathology of the urogenital tract.

What causes LUTS?

LUTS may be caused due to an acute problem like an inflammation of the prostate gland (prostatitis), urinary tract infection or less commonly, bladder stones or Prostate enlargement (benign or malignant).

Storage symptoms or overactive bladder(OAB) this condition is also defined as urgency, that may occur with or without urge incontinence, generally with nocturia. It might also symbolise an underlying chronic medical condition like high blood pressure, obesity, diabetes (high glucose levels in the blood), or obstructive sleep apnoea, or because of the effects of smoking.

Certain Lifestyle factors and choices such as too much consumption of alcohol or caffeine, or a sedentary lifestyle can worsen the storage symptoms.

Voiding symptoms occur mainly because of blockage in the outlet of the bladder that makes it hard to pass urine. The blockage occurs because of an enlarged prostate gland or a urethral stricture (scarring of the urethra). Enlargement of the prostate gland is responsible for both storage and voiding symptoms.

Some other causes of LUTS cover some medical and neurological diseases such as stroke and Parkinson’s disease.

There are also links between LUTS and depression and erectile dysfunction.

How can one prevent LUTS ?

It is quite unlikely for a man to get if he follows a healthy lifestyle and body weight. Therefore it is important that you do not smoke and gets appropriate treatment for medical conditions like diabetes, high blood pressure or sleep apnoea.

For a man suffering from LUTS, reduction in the intake of caffeine and alcohol ( these substances can irritate the bladder), avoiding straining while defecation can influence pelvic floor muscles, which are important for control of both bowel and bladder), and decreasing body weight may help to improve the symptoms.

When should I see a Urologist for LUTS?

LUTS cannot be a normal part of ageing so it is best to see your urologist when you start noticing the symptoms. if you notice any symptoms with urination, that affects your quality of life or interference with day-to-day activities. It is a false notion that urinary symptoms in men are a sign of prostate cancer, which is not true. Prostate cancer may be accompanied with certain urinary symptoms, however, most commonly it is not the case and the LUTS have other causes.

How are LUTS diagnosed?

The diagnostic tests for LUTS depend on patient’s age and details given in the medical history, that includes the type of symptoms, presence of other health ailments like diabetes, and medicines the man may be taking.

The tests may include the following:

2. DIGITAL ERECTAL EXAMINATION: A urologist places a gloved finger in the back passage (rectum) for checking the size and shape of the prostate gland and to evaluate any problems with the prostate gland.
3. URINALYSIS: urine tests are done to check any signs of infection or cancer of the urinary tract, or kidneys
4. UROFLOWMETRY

Uroflowmetry procedure Uroflowmetry procedure is a test done to measure the volume of urine excreted in a specified period of time that is also termed as Urine flow rate. It is a simple, non-invasive diagnostic screening method used for calculating the flow rate of urine in seconds and the period of completion of the void.

In this process, there is a constant recording of urine flow with the help of a device that consists of a cylinder placed on a transducer that weighs the amount of urine penetrating the cylinder during voiding and outlines the flow rate on a timescale.

When should one gets a Uroflowmetry?

• Benign prostatic hyperplasia (BPH).
• Painful urination
• Slow urination.
• Urinary incontinence
• Neurogenic dysfunction of the bladder

What is the process uroflowmetry?

Uroflowmetry is done best on a full bladder. Urologist asks the patient for holding their urine till patient has desire to pressure. Drinking extra fluids is also recommended so have plenty of urine for the test. however, no fasting or sedation is required.

Patient then needs to urinate in a special urinal or toilet that has a machine with a measuring device. After you have finished the urination, the machine will create a report for your health care provider.

What are the conclusions drawn from Uroflowmetry Test?

Alterations in the urine flow rate can be characteristic of

1. Blockages in the urethra.
2. Weak bladder muscles.
3. BLADDER DIARY: A man might be asked to keep a journal of his urination by looking at the pattern and cycle of voiding. These diaries are particularly helpful for men suffering from storage symptoms
4. PROSTATE SPECIFIC ANTIGEN (PSA) BLOOD TEST: This test is advised if the symptoms suggest that you might be suffering from the prostate disease.

PSA test is done for measuring a protein in your blood also known as prostate specific antigen (PSA). In Prostate cancer the PSA levels go higher, however, a high PSA level result doesn’t always mean a man has prostate cancer.

Sometimes PSA levels are elevated because of some benign conditions like prostatitis, BPH, urinary tract infection, can also lead to elevated PSA but that isn’t cancer.

6. ULTRASOUND: This is a method of measuring the amount of urine left in the urinary bladder after urination and for checking the prostate gland
7. CYSTOSCOPY: This makes use of a small video telescope, which is inserted into the bladder via the urethral opening.

How are LUTS treated?

While deciding for the best treatment, the urologist will consider the factors such as type of LUTS, the cause of the LUTS and other determinants like the degree of distress caused by the LUTS and lifestyle factors. Changes in lifestyle or management of other health conditions like hypertension or diabetes are usually the first option.

If symptoms are not very annoying, the best way to monitor the LUTS is through frequent checks with the urologist. If the LUTS are disturbing, oral medicines (tablets) are of great help. The medicine recommended by the urologist will depend on the type and cause of LUTS.

In some cases, several medicines are given to correct the symptoms. Surgery is done only in cases of prostate enlargement not responding to medications is the most effective strategy for reducing symptoms caused by an enlarged prostate.

LUTS TREATMENTS                   

Management of underlying conditions and lifestyle measures

• Management of medical conditions like obstructive sleep apnoea, heart conditions, obesity, hypertension, kidney conditions and diabetes; review of the effectiveness of medicines.
• Changes in diet that includes consumption of fewer calories, saturated fat, reduced alcohol intake and limit of caffeine intake only to early morning; and daily physical activity.

Oral medicines (tablets)

• Alpha-blockers – these medications relax the bladder outlet and the muscles present in the prostate gland; used to help symptoms that occurs because of prostate enlargement
• Anticholinergics (or antimuscarinics) – these medications are quite helpful in the contraction of the bladder; that helps in relieving the storage symptoms or an overactive bladder
• Phosphodiesterase inhibitors (tadalafil) – used to treat erectile dysfunction but can also help reduce storage and voiding LUTS
• 5-alpha reductase inhibitors – these medications are used in case of an enlarged prostate and usually taken in combination with alpha-blockers. However, these may result in erectile dysfunction and loss of libido (sex drive.) These are the first line of treatment for treating erectile dysfunction but can also help with reducing storage and voiding LUTS. transurethral incision of the prostate (TUIP), Holmium laser enucleation (HoLEP), Transurethral resection of the prostate (TURP), green light laser(PVP) are some

Surgery in the form of Laser Prostatectomy /TURP in cases not responding to medications.