Lower Urinary Tract Symptoms (LUTS)
Definition of LUTS
The acronym LUTS stands for lower urinary tract symptoms. It is used collectively for irritative of obstructive symptoms regardless of their cause. Lower urinary tract symptoms are subjectively perceived very differently. With the help of a voiding diary, the complaints regarding time and intensity can be documented and help to evaluate the cause of symptoms. In principle, the amount (volume) of drinking and urine is documented in tables for each hour of the day, the volumes are best measured with a measuring cup and are not only estimated. Furthermore, additional complaints such as incontinence, urgency or pain are also noted for the corresponding hour of the day.
Irritative symptoms also called storage symptoms: Urinary frequency, urgency, dysuria and nocturia.
Synonym is pollakiuria or pollakisuria. Urinary frequency is the need to urinate too often during the day while having a normal urine volume. Urinary frequency is distinguished from polyuria (urine volume more than 3 l per day). A normal objective frequency is less than 8 episodes per day.
Urgency is a sudden compelling desire to pass urine, which is difficult to defer. The maximal manifestation is urge urinary incontinence.
Dysurie is painful voiding, often described as burning or stinging sensation. The sensation often projects into the penis or urethra. Pain at the beginning of micturition is typical for a urethral disease, terminal pain speaks for bladder diseases.
Differential diagnosis of frequency, urgency or dysuria:
- Urinary tract infections: cystitis, prostatitis, urethritis.
- Reduced anatomical bladder capacity: radiation cystitis, interstitial cystitis, tuberculosis, bladder surgery, advanced bladder or prostate cancer, compression of the bladder due to tumors or pregnancy.
- Reduced functional bladder capacity: post-void residual bladder volume due to subvesical obstruction or neurogenic bladder disorders, overactive bladder, detrusor hyperreflexia, bladder stones, distal ureteral stone, foreign body in the bladder, vaginitis due to estrogen deficiency.
- Subvesical obstruction: benign prostatic hyperplasia, prostatitis, prostate cancer, urethral stricture, pelvic floor insufficiency, foreign body in the urethra.
- Pharmacological causes: diuretics, beta-blocker, theophylline or caffeine.
- Psychological causes like stress, anxiety or after sexual trauma.
The International Continence Society defines nocturia as a complaint that the individual has to wake at night one or more times to void (Kerrebroeck et al, 2002). In addition to the causes of frequency (see above), nocturia is also caused by nocturnal polyuria, for details please see causes of nocturia.
Diagnostic work-up for LUTS
Every patient with LUTS should recieve the following basic examinations:
- Physical examination with digital-rectal examination.
- Micturition diary: helps to differentiate between polyuria or reduced bladder capacity.
- Sonography of the bladder and kidney: Residual urine? Bladder pathology? Prostate size? Hydronephrosis?
- Urine analysis
For complicated or unclear cases, following examination might be helpful:
- Symptom score (IPSS)
- Laboratory tests: creatinine (if hydronephrosis is seen), PSA (for suspicious DRE or for prostate cancer screening).
- Urine flow
- Cystoscopy: in case of hematuria, very week urinary stream, unsucessful medical therapy, before surgery.
- Urodynamics: in unclear situations before surgery or if neurogenic disorders are suspected.
- Medical evaluation in nocturnal polyuria and concomitant heart or lung disease.
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