1. Lower Urinary Tract Symptoms (LUTS) in men Kamal Patel GPST2

2. Objectives Define ‘LUTS’ Causes of LUTS Initial assessment and management Not covered –Mx of acute retention –Stress incontinence –Prostate Ca

3. A 79 year-old man complains of LUTS. Which one of the following regarding BPH is incorrect? 1.Goserelin is licensed for refractory cases 2.Side effects of 5α-reductase inhibitors include ejaculation disorders and gynaecomastia 3.Possible presentation include recurrent UTI 4.5α-reductase inhibitors typically decrease the PSA 5.More common in black men.

4. LUTS: definition Storage (irritative) symptoms: –Urgency –Urinary frequency –Nocturia –Urinary incontinence Voiding (obstructive) symptoms –Hesitancy, poor stream, terminal dribbling

5. Causes of LUTS Obstructive –BPH –Prostate/bladder/rectal cancer –Bladder neck/urethral strictures –Antimuscarinic drugs –Autonomic neuropathy/neurogenic bladder

6. Causes of LUTS Irritative –BPH –Bladder/prostate cancer –Infection –Bladder stones –Neurological Dementia Diabetes Stroke

7. Assessment History – type of LUTS, duration of Sx, how bothersome are they? Examination – abdomen (distended bladder), external genitalia, DRE International Prostate Symptom Score: –Used to assess severity of symptoms –Score of 0-5 for seven symptoms (total 35): 0-7 – mildly symptomatic 8-19 – moderately symptomatic 20-35 – severely symptomatic

8. A 62 year-old man presents with nocturia, hesitancy and terminal dribbling. DRE reveals a moderately enlarged prostate with no irregular features. PSA1.3 What is the most appropriate mx? 1.Alpha antagonist 2.5-alpha reductase inhibitor 3.Non-urgent referral for TURP 4.Empirical tx with cipro for 2 weeks 5.Urgent referral to urology.

9. A patient is started on finasteride for the management of BPH. How long should the patients be told that treatment may take to be effective? 1.Within 8hrs of taking the tablet 2.Within 3 days 3.Up to 7 days 4.Up to 4 weeks 5.Up to 6 months

10. Management Urine dip +/- culture U&E –Chronic retention –Recurrent UTI –Hx of renal stones PSA Urinary frequency-volume chart –Ask patient to note down when they drink fluid/pass water and to comment on type of fluid –Allows to differentiate between frequency of urine, polyuria and nocturia

11. Obstructive symptoms –Lifestyle changes. –Alpha blocker: e.g tamsulosin –5α – reductase inhibitors Irritative symptoms –Exclude/manage treatable causes –Urine containment devices –Supervised bladder retraining –Anticholinergics e.g oxybutinin

12. Thank You