Lower Urinary Tract Symptoms

LUTS is a relatively new term coined to lessen the confusion causedbyterms such as prostatism, symptomatic obstructive uropathy, etc. They comprise three groups of symptoms: storage, voiding, and postmictu-

rition symptoms (Abrams et al. 2002). Storage symptoms include frequency, nocturia, urgency, and urgency incontinence. It is important to differentiate a normal urge to void and urgency, and similarly nocturia from nocturnal polyuria. Voiding symptoms include hesitancy, poor stream, intermittency, straining to void, incomplete bladder emptying, and UR. A case can be made for considering enuresis secondary to chronic retention - overflow incontinence - as both a storage and a voiding disorder. Postmicturition symptoms include terminal and postmicturition dribbling.

Clearly these symptoms are not disease-specific and a wide range of other disease states can cause LUTS. These include neurological conditions such as those mentioned above, malignancy (including prostate cancer and urothelial tumors), inflammatory conditions (including UTI, bladder stones, interstitial cystitis), polyuria (diabetes, congestive cardiac failure), and other causes of BOO, including bladder neck or external sphincter dyssynergia, urethral stricture (see Sect. 11.2.4) and severe phimosis. Some symptoms such as a poor urine stream are also found in conditions such as detrusor underactivity or detrusor failure, which do not necessarily have an obstructive component.

The role of inflammation within the prostate has also been investigated recently, with several series showing that in tissue samples from prostates of patients in AUR, there is more inflammation than in prostates with BPH/BOO, which in turn have more inflammation than normal prostates (Anjum et al. 1998; Roehrborn 2006b; Tuncel et al. 2005).

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