2. Definition
• Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms
involving the bladder, urinary sphincter, urethra and in men, the prostate.
• The term is more commonly applied to men. Over 40% of older men are
affected, but lower urinary tract symptoms also affect women.
• The condition is also termed prostatism in men, but LUTS is preferred.
3. Epidemiology
• Prevalence increases with age. The prevalence of nocturia 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.
• Once symptoms arise, their progress is variable and unpredictable
with about one third of patients improving, one third remaining
stable and one third deteriorating
4. Signs and symptoms
Filling/storage/irritative symptoms:
• Increased frequency of urination
• Increased urgency of urination
• Urge incontinence
• Excessive passage of urine at
night/Nocturia
• Nocturnal Incontinence
Voiding or obstructive symptoms:
• Poor stream
• Hesitancy
• Terminal dribbling
• Incomplete voiding
• Urinary retention
• Overflow incontinence (occurs in
chronic retention)
• Episodes of near retention
5. Causes
• Benign prostatic hyperplasia (BPH)
• Bladder stone
• Cancer of the bladder and prostate
• Detrusor muscle weakness and/or instability
• Diabetes
• Use of ketamine
• Neurological conditions; (e.g.: multiple sclerosis, spinal cord injury etc)
• Prostatitis, including IgG4-related prostatitis
• Urethral stricture
• Urinary tract infections (UTIs)
7. International Prostate Symptom Score (IPSS)
• IPSS is an 8 question written screening tool used to screen for,
rapidly diagnose, track the symptoms and suggest management of
the LUTS of benign prostatic hyperplasia (BPH).
• It contains 7 questions related to symptoms related to BPH and 1
question related to the patient's perceived quality of life.
IPSS score (out of 35)
Total Score Correlation
0-7 Mildly symptomatic
8-19 Moderately symptomatic
20-35 Severely symptomatic
8. IPSS Scoring (contd.)
F Frequency
U Urgency
N Nocturia
W Weak stream
I Intermittency
S Straining
E Sensation of incomplete emptying
The mnemonic "FUN WISE" can be used to remember the seven
questions relating to symptoms of BPH. They are as follows:
The symptoms must have been
experienced in the last month and each
answer is scored from 0 to 5 for a
maximum score of 35 points.
9. IPSS Scoring (contd.)
• The first six questions are scored based on the following:
0 Not at all
1 Less than 1 time in 5
2
Less than half the
time
3 About half the time
4
More than half the
time
5 Almost always
• The seventh question, relating to nocturia,
is scored from 0 to 5 based on how many
times the patient gets up at night to
urinate (i.e. 1 is scored for one time per
night and 5 for five times per night).
• The eighth, and final question (not
included in the main IPSS score), relating
to the patient's perceived quality of life, is
assigned a score of 0 (delighted) to 6
(terrible).
11. Treatment (contd.)
• Surgical Treatment:
Ablation procedures - used in treating both bladder tumours and bladder
outlet obstruction, such as prostate conditions.
Bladder-neck incision (BNI)
Removal of the prostate - open, robotic, and endoscopic techniques are used.
Stenting of the prostate and urethra.
Transurethral resection of the prostate (TURP)
Transurethral microwave thermotherapy
Urethral dilatation (a common treatment for strictures)
