Evaluation of the patient with LUTS

Voiding symptoms

• Weak stream.
• Hesitancy.
• Intermittency.
• Straining to void.
• Prolonged voiding.

Storage symptoms

• Increased urinary frequency.
• Urgency.
• Nocturia.
• Urgency urinary incontinence.

Postmicturition symptoms

• Sensation of incomplete emptying.
• Postvoid dribbling.

What to ask?

The evaluation should include:

• Characteristics and duration of symptoms.
• Medications.
• Medical and neurological history.
• Previous surgeries.
• Habits.
• Comorbidities.
• Sexual function.
• Impact of symptoms on quality of life.

IPSS

The International Prostate Symptom Score allows symptom severity to be quantified.

It also includes a quality-of-life question that helps guide the need for treatment.

Initial tests

Depending on the clinical context, the following may be used:

• Urinalysis.
• PSA.
• Postvoid residual.
• Uroflowmetry.
• Renal and bladder-prostate ultrasound.
• Renal function when indicated.

Urinalysis is part of the initial evaluation of LUTS in men.

Uroflowmetry provides an objective measurement of flow, although a low flow cannot by itself distinguish obstruction from detrusor underactivity.