Lower Urinary Tract symptoms in men

Question 1

causes

Answer 1

BPH
prostate ca

Question 2

examination

Answer 2

urinalysis
dre
psa

Question 3

what may help guide management

Answer 3

urinary frequency volume chart

international prostate symptom score (IPSS)

Question 4

mx for voiding issues

Answer 4

conservative measures include: pelvic floor muscle training, bladder training, prudent fluid intake and containment products

if ‘moderate’ or ‘severe’ symptoms offer an alpha-blocker

if the prostate is enlarged and the patient is ‘considered at high risk of progression’ then a 5-alpha reductase inhibitor should be offered

if the patient has an enlarged prostate and ‘moderate’ or ‘severe’ symptoms offer both an alpha-blocker and 5-alpha reductase inhibitor

if there are mixed symptoms of voiding and storage not responding to an alpha blocker then a antimuscarinic (anticholinergic) drug may be added

Question 5

Mx for overactive bladder

Answer 5

conservative measures include moderating fluid intake

bladder retraining should be offered
antimuscarinic drugs should be offered if symptoms persist.

NICE recommend oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)
mirabegron may be considered if first-line drugs fail

Question 6

Mx for nocturia

Answer 6

advise about moderating fluid intake at night

furosemide 40mg in late afternoon may be considered

desmopressin may also be helpful