Appropriate workup for lower urinary tract symptoms in men

摘要

For most men with lower urinary tract symptoms (LUTS), the initial workup should consist of a careful history and physical examination, with or without simple adjunctive tests (e.g., uroflowometry, post-void residual, and frequency volume charts). Based on this basic workup, one is usually able to make an informed selection of initial treatment or watchful waiting. Urodynamics, cystoscopy and imaging are most useful in select cases when a specific reason is identified, the diagnosis is uncertain or when patients have failed simple initial treatments and seek further therapy. Lower urinary tract symptoms (LUTS) are extremely common in men and increase with age. LUTS can be broadly divided into storage symptoms (urgency, frequency, urgency incontinence, nocturia) and voiding symptoms (slow stream, hesitancy, feeling of incomplete emptying). Voiding and storage symptoms often coexist. In general, voiding symptoms are caused by either outlet obstruction or impaired contractility, while storage symptoms are related to detrusor overactivity, increased bladder sensitivity or impaired compliance. Before treating LUTS, it is important to ascertain the type of symptoms (voiding, storage, or both), as well as the severity and degree of bother of both. The amount of information needed from the workup depends upon the complexity of symptoms, presence of comorbidities (e.g., neurological disease, diabetes) and any abnormalities found in the initial basic workup (e.g., very high post-void residual [PVR]). The following review discusses what the author feels is an appropriate workup of a male patient with LUTS. In discussing implementation of initial or simple treatments we are referring to behavioural therapy, pharmacologic therapy (e.g., alpha-blockers, 5-alpha reductase inhibitors, antimuscarinics) and physiotherapy.