Urology is the scientific study of the diseases affecting the urinary tract system in both males and females.
You would generally have to consult a urologist to treat various conditions such as kidney blockage, kidney stones, urinary tract infections, kidney cancer, bladder cancer, and other bladder problems.
Most men develop prostatic hyperplasia as they advance in age, especially towards the age of eighty.
Historic correlation and assumptions suggest that the lower urinary tract symptoms result in an obstruction of the bladder outlet due to the enlargement of the prostate. In addition to this, since many non-urological and non-urological conditions can result in lower urinary tract symptoms in ageing men, it is essential to manage and diagnose them properly.
Though more commonly observed in men, lower urinary tract symptoms are not restricted to them and can also be observed in women. Research demonstrates a significant increase in the percentage of LUTS among men above the age of sixty.
What Are LUTS?
Prostate enlargement and lower urinary tract symptoms are closely linked in ageing men. Nevertheless, bladder outlet obstruction (BOO) (also referred to as prostatism), benign prostatic hyperplasia (BPH), and Lower Urinary Tract Symptoms are not considered to be causally related despite occurring in combination in certain instances.
Moreover, Lower Urinary Tract Symptoms can also develop due to various other clinical conditions such as Parkinson’s disease, urinary tract infection, diabetes mellitus, congestive heart failure, and prostate cancer, among others.
Lower Urinary Tract Symptoms primarily include the following obstructive or voiding symptoms caused by flaws in the pelvic floor muscle:
- Intermittent stream
- Poor stream
- Incomplete bladder emptying
- Prolonged micturition
The severity of lower urinary tract symptoms is measured quantitatively by the American Urological Association symptom index.
How Is LUTS Diagnosed?
Lower urinary tract symptoms can be diagnosed accurately by identifying the underlying medical conditions. Your urologist would review your medical history, any current clinical conditions, and the medications. He would also recommend a physical examination, urine analysis, imaging, blood tests, and even a rectal exam to study the prostate gland.
If you experience any irritation or difficulty passing the urine, you must visit your nearest urologist.
What Are the Diagnostic Processes for Lower Urinary Tract Symptoms?
Your urinary doctor would recommend and follow the following procedures to accurately diagnose lower urinary tract symptoms.
- Patient score: A validated assessment of lower urinary tract symptoms is performed by objective assessment and quantifiable metrics during the initial study. This is an in-depth system built by the International Prostate Symptom Score (IPSS) and the American Urologic Association (AUA). This consists of questions on voiding symptoms on a five-point scale.
- Frequency volume charts and tables: These are also known as voiding diaries and are inexpensive and affordable. These can help the doctor gain valuable insights into the patient’s voiding history. Despite the lack of proper protocol, these diaries provide better data about the patient than the questionnaire and are considered especially useful in patients suffering from nocturia.
- Additional medical history: It is vital that you also discuss other clinical conditions with your urinary doctor that could have triggered lower urinary tract symptoms such as diabetes, cardiovascular diseases, neurologic diseases, and sleep disorders. It would be best to mention any previous urinary tract examination such as catheterization and other invasive procedures beforehand. In addition to this, it is also essential to consider various drugs such as α blockers and anticholinergics.
- Imaging: Your urinary doctorwould also suggest some non-invasive forms of testing such as urine studies to identify urinary tract infections, glucosuria, and haematuria.
- Serum creatinine: Your doctor would assess your serum creatinine levels to rule out medical conditions such as obstructive uropathy.
- Prostate-specific antigen: A prostate-specific antigen test is performed, especially in cases where benign prostatic hyperplasia (BPH) and bladder outlet obstruction can be linked. This test helps in the explicit identification and diagnosis of prostate cancer.
- Post void residual urine volume: The post-void residual urine volume is a non-invasive transabdominal ultrasound that helps to quantify the residual urine left in the bladder. This technique cannot help differentiate obstructive urinary retention and neurogenic urinary retention but can help diagnose various other medical conditions arising from an overactive bladder.
- Peak urine flow rate: Like residual volume, flow rate also helps identify the proper functioning of the bladder outlet and the bladder function. Therefore, a flow rate less than 10ml/s suggests an increased probability of bladder obstruction preventing a smooth urine release.
- Pressure flow studies: Pressure-flow studies are now considered the gold standard for the diagnosis of lower urinary tract symptoms. The distinction between various medical conditions is made by the detrusor pressure and flow rate.
- Prostate ultrasonography: This, too, is considered a gold standard for the accurate diagnosis of lower urinary tract symptoms wherein the prostate is imaged using ultrasound.
- Endoscopy: Although not generally recommended, a cystourethroscopy provides a lot of information regarding the prostate’s shape and any other comorbid etiologies such as a stricture.
- Other imaging techniques: Your urologist can employ other imaging techniques on the subjects, such as renal ultrasonography, computed tomography, MRI, and intravenous urography.
- Physical examination: Your urinary doctor would also perform the following physical analyses:
- Abdominal examination
- Genitourinary examination
- Digital rectal examination
- Focussed neurologic examination.
Although lower urinary tract symptoms primarily develop in older individuals, they have no direct relationship to age. While a variety of causative factors are associated with lower urinary tract pathophysiology, it is necessary to identify and correctly diagnose the medical condition causing the discomfort.
Various medical techniques and procedures are now available to help identify the root cause and provide significant relief from the medical condition.
NCBI Pubmed Central (PMC) lists an array of demonstrated techniques and studies for the diagnosis of LUTS.
If you are living in Tamil Nadu and are facing discomfort and changes in your urinary system mentioned above, you must visit a urinary infection doctor in Coimbatore in case of any urinary infections.
You could also undergo prostate treatment in Coimbatore if you’ve been diagnosed with an enlarged prostate. Your urologist may perform a urology surgery to treat the medical conditions depending on the severity.
Therefore, it is essential to observe your symptoms and visit your urologist for an appropriate treatment program for faster relief.