Initial specialist assessment of lower urinary tract symptoms (LUTS) in men
Specialist assessment refers to assessment carried out in any setting by a healthcare professional with specific training in managing LUTS in men (1):
- assess general medical history to identify possible causes of LUTS, and associated comorbidities. Review current medication, including herbal and over-the-counter medicines to identify drugs that may be contributing to the problem
- offer a physical examination guided by urological symptoms and other medical conditions, an examination of the abdomen and external genitalia, and a digital rectal examination (DRE)
- men with LUTS should be asked to complete a urinary frequency volume chart
- offer men with LUTS information, advice and time to decide if they wish to have prostate specific antigen (PSA) testing if:
- their LUTS are suggestive of bladder outlet obstruction secondary to BPE or
- their prostate feels abnormal on DRE or
- they are concerned about prostate cancer
- offer men with LUTS measurement of flow rate and post void residual volume
- cystoscopy to men with LUTS having specialist assessment should on be offered when clinically indicated, for example if there is a history of any of the following:
- recurrent infection
- sterile pyuria
- haematuria
- profound symptoms
- pain
- imaging of the upper urinary tract to men with LUTS having specialist assessment should only be offered when clinically indicated, for example if there is a history of any of the following:
- chronic retention
- haematuria
- recurrent infection
- sterile pyuria
- profound symptoms
- pain
- multichannel cystometry should be considerd for men with LUTS having specialist assessment if they are considering surgery
- pad tests to men with LUTS should only be offered if having specialist assessment if the degree of urinary incontinence needs to be measured
Reference:
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