LUTS

Question 1

What are LUTS? LUTS division?

Answer 1

Stands for lower urinary tract symptoms.

Storage symptoms : altered bladder sensation, increased daytime frequency, nocturia, urgency.

Voiding symptoms : hesitancy, intermittency, slow stream, spraying and straining.

Question 2

What is benign prostatic hyperplasia? Bladder outlet obstruction?

Answer 2

The prostate has a volume of 15-25ml and is checked with the digital rectal exam.

BPH—> is very common in aging males and means that the prostate is growing in volume, this could lead to LUTS like improper emptying of the bladder.

BOO—> impossibility to empty bladder due to an obstruction which may be functional.

Question 3

International prostate symptom score?

Answer 3

The International Prosthetic Symptom Score, IPSS, is a seven-question score. Useful to address the baseline of your patient.

Question 4

Diagnosis of LUTS?

Answer 4

1st level —> medical history, symptomatology, IPSS score, PSA test, DRE and physical exam.

2nd level —> transrectal US evaluation, uroflowmetry, renal US, pressure flow study and cystoscopy.

Question 5

Treatment of LUTS due to BPH?

Answer 5

Supportive management for patients with low score and risk.

Medical treatment such as alpha1 blockers and 5alpha reductase inhibitors. These drugs can reduce contraction and hyperactivity of bladder neck and prostate.

Phytotherapy can be used in patients that do not want to be treated with other drugs.

Question 6

Surgery for LUTS?

Answer 6

Indication for therapy include medical therapy ineffectiveness, chronic urinary retention, UTIs, gross hematuria (DDX bladder cancer), bladder stones.

• Transurethral resection of the prostate is gold standard, it is safe and widely used with a short hospital stay. It does have risks of bleeding, retrograde ejaculation, and urinary retention.
• Transurethral incision of the prostate.
• Laser treatments for prostate.