Approach to pt with LUTS

LUTS

History 

LUTS History

Voiding
Storage
Onset, duration, severity, impact/troublesome nature

Incontinence (Stress, urge), Nocturia

Ask specifically about 

Bedwetting (HPCR)

Storage symptoms and bladder pain (CIS)

Visible haematuria (Bladder, Kidney ca, stones) 

Back pain, Neurological symptoms

Lifestyle 
Fluid intake
adjustments tried by pt


Bowel function red flag (change of bowel habit, weigt loss, rectal bleeding, fh of bowel ca)

Sexual function 

General Anorexia, weight loss, tiredness, leg swelling.

If female obstetrics and gynaecological history

Smoking Hx 

Occupational Hx 

Travel Hx 

Surgical Hx 
urethral injury/instrumentation
pelvic surgery
Radiotherapy


Medical Hx
Diabetes
HTN
Neurological disease (Parkinson, MS)

Family Hx
Urological cancer

Medication Hx 
Diuretics
Sympathomimetic and anticholinergics


Observation
Fluid overload, signs of uraemia
Tremor, gait disturbance
Visible full bladder

Examination
Abdomen (palpable bladder, ballotable kidney)
Enlarged kidneys
Genitals testicle, penis (phymosis, meatal stenosis)
DRE (prostate size, consistency, nodules)
Neurological exam (perianal sensation) (anal tone and sensation)


Questionnaire

IPSS
8 items questionnaire, 7 urinary symptoms, one quality of life (0-7, 8-19, 20-35)
FVC  (Polyuria, nocturnal polyuria)

Tests

Urinalysis (blood, glucose, protein, leucocytes, nitrites)

Serum creatinine and eGFR if suspected renal impairment.
PSA if LUTS suggestive of BOO/BPE, abnormal feeling prostate, pt concerned.

Optional tests
Flow rate, PVR
Urodynamics

USS KUB not routine
if creatinine is high or
loin pain
haematuria
renal enlargement or mass on exam

Cystoscopy not routine
useful if history of
Haematuria
Equivocal flow rate
Previous Urological surgery

TRUS not routine
indicated if
high PSA
Abnormal DRE
Surgical planning

Urodynamic before surgical intervention
Equivocal flow rates VV < 150, Q max >10 ml
Age <50 >80
Previous unsuccessful treatment for BPH
Neurological disease