Lower Urinary Tract Symptoms

Men can develop problems with voiding urine with increasing age. In men this can be due to prostate enlargement (BPE) or due to an overactive bladder or a combination of both.

Assessment of LUTS

Symptoms which are suggestive of a poor urinary flow and incomplete bladder emptying or straining to void are suggestive of bladder outflow obstruction. In men this obstruction may be at the level of the bladder neck, prostate or due to a urethral stricture. An examination of the prostate will assess the size and detect any obvious malignancy. Further investigations can be performed to measure the flow rate and scan the bladder after voiding (post micturition bladder volume). A questionnaire called the IPPS can also be used to determine the degree of bother that the symptoms are causing the individual.

Treatment of bladder outflow obstruction

If the investigations suggest that the problem is due to obstruction at the level of the prostate gland then treatment using oral medication can be started in the form of an α blocker eg tamsulosin, alfuzocin. These reduce the tone in the prostate and improve the symptoms. Failure of oral medication may lead onto surgery which is performed endoscopically through the urethra. There are now various techniques available to perform surgery on the prostate to improve voiding eg bipolar TURP, HoLEP.

Add video from YouTube of HoLEP procedure

Treatment of overactive bladder

Symptoms suggestive of overactive bladder include having to go to the toilet to pass urine very often (urinary frequency) and also rushing to the toilet (urinary urgency). Initial treatment involves dietary modifications and lifestyle modifications but if this does not resolve the symptoms then medication such as anticholinergics (Solifenacin, Regurin, Detrusitol) can be used.

Urodynamic Studies

In younger age groups or where the diagnosis is unclear urodynamic studies may have to be performed to establish whether the underlying problem is due to an overactive bladder or due to bladder outflow obstruction. This is performed in our hospital using videourodynamics by using fine calibre pressure lines inserted into the bladder to measure the filling and voiding pressure. The bladder is also visualised on an imaging screen to check for any bladder neck descent.

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