LUTS Men

Reference

• LUTS Men - PCKB

Assessment

• Storage - Urgency

• Voiding - Straining, hesitancy, drawn out urination, terminal dribbling

• Overlap - Frequency = either bladder not filling properly or not emptying properly

  • Make 100mL urine per hour roughly

Red Flags

• Prostate cancer

  • Advanced - Back pain, neurological anaemia

  • Early - No specific symptoms except outflow

  • Ask about why you are here? = Ask about concern about prostate cancer or do you want to improve your symptoms?

  • DRE + PSA

• Bladder Cancer

  • Smokers

  • Frank painless haematuria

• Men don’t get UTIs

  • If UTI and male > 50 consider investigating for more sinister causes

Case 1

• 72yo, 7/12 of frequency and nocturia, 4-6 weeks of straining, no terminal dribbling, no incomplete emptying, no haematuria or dysuria, no back pain or night sweats, on Ramipril and Atorvastatin

• Normal to get up through night x 1 in 60s, x 2 in 70s and x 3 in 80s

• Voiding diary useful (how often, how much in 24 hours should be 1.5 to 2L)

• Straining = probably obstructive = prostate

• Start with alpha-blockers, work quickly (Tamsulosin - if works then can take indefinitely)

• Would consider DRE + PSA

• Fruit - Walnut, Plum , Tangerine, Orange = 60g

PSA

• Blood test

• Gives you relative risk for prostate cancer

• Higher = more likely only

• False positives = can be raised and no cancer

• Normal DRE + PSA upper limit of normal + no family history = 3% chance of biopsy showing significant cancer

• If referring on to specialist

  • PSA, UEC, Urine MCS

  • Ultrasound for PVR if able

BPH

• Alpha blocker and review 2 to 4 weeks

  • Warn about hypotension

• Finasteride / Dutasteride

  • Long term shrinkage of prostate over 3 to 6 months

  • Reduces PSA by 20 to 80%

Case 2

• As above except PSA is 8.1

• Refer on to Urology

• Start medication for symptoms

Case 3

• 60yo, incontinence, T2DM + HTN, normal UEC

• Nocturnal enuresis = bad

• Decrease weight

• Decrease caffeine

• Treat T2DM

• Consider anticholinergic

• Urine MCS to exclude haematuria

• Ultrasound