Lower Urinary Tract Symptoms (LUTS)

This is the collective term to describe urinary symptoms and has replaced terms such as prostatism.

Broadly speaking urinary symptoms fall into 2 types. There are symptoms due to reduced flow such as hesitancy (difficulty getting the flow going), intermittent flow (straining to pee), weak stream (slow flow) and incomplete emptying. In men this often means that the prostate is enlarged, which compresses the water pipe and so reduces flow. The prostate can be enlarged due to the natural growth that occurs as a man ages (BPE=benign prostatic enlargement), it can be due to prostate cancer or a combination of both. The symptoms imply obstruction of the flow and are not indicative of the cause. Occasionally the symptoms can be due to bladder muscle not working as well i.e not enough pump pressure. (stops and starts),

The other type of bladder symptoms occur due to difficulty holding onto urine, which typically results in a patient peeing too frequently, having to rush to find a toilet (urgency) and sometimes incontinent episodes. Often getting up at night to pee is also a problem (nocturia).

Unfortuanely the symptoms often overlap e.g.frequency from not emptying the bladder, as your bladder is always half full.

To help me assess your symptoms it is very helpful if you print and fill in an International Prostate Symptom Score IPSS chart that can be found in the chart section.

HAEMATURIA (blood in the urine)

If you see blood in the urine it is termed macroscopic haematuria. If you do not see blood in the urine but it registers on a dipstick test it is termed microscopic haematuria.

Whilst the commonest cause is a urine infection, blood in the urine should be investigated as it can be due to an underlying cancer either in the bladder or kidneys. There are several non-cancerous causes such as kidney stones, bladder stones or the kidneys just leaking a small amount of blood.

It is standard practice to undergo the following investigations:

Urine culture MSU=mid stream urine)-to see if there is an infection

Urine cytology urine examined for cancerous cells (useful for aggressive cancers)

Flexible cystoscopy-inside of the bladder examined directly with fine flexible telescope under local anaesthetic (takes 10 minutes). Alternatively this can be performed under general anaesthetic

Kidney ultrasound-Kidneys examined using ultrasound

CT scan-kidneys examined using CT scanner, often given an injection of contrast