Lower urinary tract symptoms (LUTS) are a common problem affecting approximately 40% of older men. LUTS is a recent term for what used to be known as prostatism.

Voiding or obstructive symptoms

• Poor stream
• Hesitancy
• Terminal dribbling
• Incomplete voiding
• Overflow incontinence (occurs in chronic retention)

As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer

Prostate cancer

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...

. Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.

Epidemiology

• Prevalence increases with age. The prevalence of nocturia
  Nocturia
  Nocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly...
  
   in older men is about 78%. Older men have a higher incidence of LUTS than older women.

• Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia
  Benign prostatic hyperplasia
  Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
  
  .

• Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.

• It is estimated that the lifetime risk of developing microscopic prostate cancer is about 30%, developing clinical disease 10%, and dying from prostate cancer 3%.

Assessment

The International Prostate Symptom Score

International Prostate Symptom Score

The International Prostate Symptom Score is an 8 question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the disease benign prostatic hyperplasia...

 (IPSS) can be used to gauge the symptoms, along with physician examination. Other primary and secondary tests are often carried out, such as a PSA (Prostate-specific antigen) test, urinalysis

Urinalysis

A urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...

, ultrasound

Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

, urinary flow studies, imaging, temporary prostatic stent

Prostatic stent

A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...

 placement, prostate biopsy

Prostate biopsy

Prostate biopsy is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. It is typically performed when the scores from a PSA blood test rise to a level that is associated with the possible presence of prostate cancer.The procedure,...

 and/or cystoscopy

Cystoscopy

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...

.

Placement of a temporary prostatic stent

Prostatic stent

A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...

 as a differential diagnosis test can help identify whether LUTS symptoms are directly related to obstruction of the prostate or to other factors worth investigation.

Possible causes of the lower urinary tract symptoms

• Benign prostatic hyperplasia
  Benign prostatic hyperplasia
  Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
  
   (BPH) with obstruction
• Detrusor muscle
  Detrusor urinae muscle
  The detrusor urinae muscle, also detrusor muscle, muscularis propria of the urinary bladder and muscularis propria, contracts when urinating to squeeze out urine. Otherwise, it remains relaxed to allow the bladder to fill...
  
   weakness and/or instability
• Urinary Tract Infection
  Urinary tract infection
  A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
  
   (UTI)
• Chronic prostatitis
  Prostatitis
  Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
  
  
• Urinary stone
• Malignancy
  Malignant
  Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
  
  : prostate or bladder
• Neurological disease, e.g. multiple sclerosis
  Multiple sclerosis
  Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
  
  , spinal cord injury, cauda equina syndrome
  Cauda equina syndrome
  Cauda equina syndrome ' is a serious neurologic condition in which there is acute loss of function of the lumbar plexus, neurologic elements of the spinal canal below the termination of the spinal cord.-Causes:...
  
  

Treatment

A number of techniques to destroy part or all of the prostate have been developed.

Techniques include:

• Transurethral microwave thermotherapy
  Transurethral microwave thermotherapy
  Transurethral microwave thermotherapy is one of a number of effective and safe procedures used in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia . TUMT provides a one-time efficacious treatment of LUTS due to BPH...
  
  
• Thermal ablation
• High intensity focused ultrasonography
• Transurethral needle ablation
  Transurethral needle ablation of the prostate
  Transurethral needle ablation is a technique that uses low energy radio frequency energy delivered through two needles to ablate excess prostate tissue. It can be done with a local anesthetic on an outpatient basis...
  
  
• Laser prostatectomy
  Prostatectomy
  A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
  
  .
• Intraurethral prostatic stent
  Prostatic stent
  A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...
  
  ing and balloon dilatation of the prostate.

Other treatments include lifestyle advice and alpha blocker therapy. Although surgical treatment is generally reserved for men who have failed or are unable to tolerate drug treatment, or for those who have developed complications

Use of the term LUTS in diagnosis codes of ICD 9 CM

• 600.00 Hypertrophy (benign) of prostate w/o urinary obstruction and other lower urinary tract symptoms (LUTS)
• 600.01 Hypertrophy (benign) of prostate with urinary obstruction and other LUTS
• 600.20 Benign localized hyperplasia of prostate w/o urinary obstruction and other LUTS
• 600.21 Benign localized hyperplasia of prostate with urinary obstruction and other LUTS
• 600.90 Hyperplasia of prostate, unspecified, w/o urinary obstruction and other LUTS
• 600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other LUTS