Lower urinary tract symptoms (LUTS) in males: a review of pathophysiology

Figures & data

Table 1: Causes of LUTS

Prostate

Benign prostatic hypertrophy

Prostatitis

Bladder

Overactive bladder

Urinary tract infection

Neurogenic bladder

Bladder calculus

Bladder tumour

Foreign body

Detrusor underactivity

Miscellaneous

Distal ureteric calculus

Urethral stricture

Table 2: Current definition of Metabolic Syndrome³¹

Adult Treatment Panel III criteria

1. Abdominal obesity (for men, waist circumference > 102 cm)

2. Hypertriglyceridaemia (> 1.69 mmol/L; > 150 mg/dL)

3. Low high-density lipoprotein cholesterol (for men, < 1.04 mmol/L; < 40 mg/dL)

4. High blood pressure (> 130/85 mm Hg)

5. High fasting glucose (> 6.1 mmol/L; > 110 mg/dL)

Additional criteria

1. Increased C-reactive protein

2. Autonomic-sympathetic overactivity

Table 3: Evaluation of male patient with LUTS

History

LUTS (irritative or obstructive)

Associated haematuria

Past medical and surgical history

Concomitant medical conditions, Diabetes Mellitus, hypertension, hypercholesterolaemia)

Medication history (including testosterone supplementation)

Previous urological surgery

Risk factors for stricture including catheterisations, perineal trauma, previous urethritis

Risk factors for haematuria including smoking, radiation, occupational exposure, bilharzia, bladder calculi

Family history of BPH

Physical examination

Including: Body mass Index

Abdominal circumference

Full abdominal and genital examination

Focused neurological examination

Digital rectal examination

Investigations

Urine dipstick – proceed to microscopy and culture if abnormal result

Urea and electrolytes

Prostate specific antigen (PSA)

Ultrasound kidney for renal impairment or chronic retention

Figure 1: Algorithm for initial management of LUTS

Kasturi S, Russell S, McVary KT. Metabolic syndrome and lower urinary tract symptoms secondary to benign prostatic hyperplasia. Curr Urol Rep. 2006;7:288–92.10.1007/s11934-996-0008-y

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