Diagnosis of LUTs in Primary care

 

ADAPTED from NICE 97 management of LUTs in men may 2010

Presentation with LUTs symptoms

Consider:

  1. Co-morbidities e.g. diabetes

  2. Medication - diuretics, herbal remedies, OTC Rx

Voiding symptoms:

  1. Weak stream

  2. Intermittency

  3. Straining

  4. Hesitancy

  5. Incomplete bladder emptying

Storage symptoms:

  1. Daytime frequency

  2. Nocturia

  3. Urgency

  4. Urgency incontinence



Consider:

  1. Severity of symptoms and impact on  lifestyle can be assessed by the IPSS score

Examination

  1. Abdominal examination

  2. palpable/ percussable bladder

  3. External genitalia e.g. phimosis

  4. Digital rectal examination (DRE)

Investigations:

  1. Urinalysis

  2. Blood - ? UTI or ? malignancy

  3. Glucose -  ? DM

  4. Protein - ? CKD

  5. Leucocytes -  ? UTI or ? cancer

  6. Nitrite -  UTI

Investigations:

  1. U&E -  ? CKD

  2. Blood sugar  - ? DM

Investigations:

  1. PSA  ( see guidance ) - offer if

  2. Voiding symptoms ? bladder outlet obstruction

  3. DRE abnormal

  4. Patient concern