Introduction

Learning objectives

Classify lower urinary tract symptoms as storage, voiding, and postmicturition symptoms.
Recognize that LUTS does not automatically equal benign prostatic hyperplasia.
Use the IPSS to quantify symptom severity and its impact on quality of life.

Video lesson

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Video pending upload (embedded YouTube)

Summary

Lower urinary tract symptoms, or LUTS, describe disturbances related to the storage and emptying of urine.

They are not a diagnosis.

Storage symptoms

They occur while the bladder is storing urine:

increased frequency;
urgency;
nocturia;
urinary incontinence.

Voiding symptoms

They occur during urination:

weak stream;
hesitancy;
intermittency;
straining;
prolonged voiding.

Postmicturition symptoms

sensation of incomplete emptying;
postvoid dribbling.

A common mistake

In an older adult man:

LUTS ≠ automatically BPH.

The symptoms may be related to different conditions:

prostatic enlargement;
overactive bladder;
urethral stricture;
infection;
neurologic disorders;
detrusor dysfunction;
medications.

IPSS

The International Prostate Symptom Score helps quantify symptoms:

Score	Severity
0–7	Mild
8–19	Moderate
20–35	Severe

It also assesses how much the symptoms affect quality of life.

Key concept

First we describe which symptoms the patient has. Then we investigate which disease is causing them.

PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

Practical algorithm

What is wrong with the patient? → history.
What symptoms does the patient have? → characterize them correctly.
What do I find? → focused physical exam.
What is my diagnostic hypothesis?
Which test do I really need to answer it?
Is there any situation that requires referral or urgent treatment?

To remember

Urologic semiology is not about ordering many tests, but about formulating the clinical question correctly and choosing the test that can answer it.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Lower urinary tract symptoms (LUTS)