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Initial specialist assessment of lower urinary tract symptoms (LUTS) in men

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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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