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Lower urinary tract symptoms may be:
Risk factors associated with LUTS include:
Consider the symptoms – are they predominantly voiding or storage?
Assess impact of symptoms:
Benign Prostatic Hyperplasia is not a risk factor for prostate cancer.
NICE recommend offering a PSA test in men under 70 who have LUTS suggestive of benign prostatic hyperplasia, an abnormal digital rectal examination or concerns about prostate cancer (after adequate counselling). Men should be given time to consider whether they wish to have a PSA test.
There is a need to wait for one week after a digital rectal examination and one month after treatment for a UTI before undertaking a PSA test. The patient should avoid ejaculation and vigorous exercise for 48 hours.
Management prior to referral:
Straightforward LUTS can be reasonably managed in primary care.
Conservative treatment options for storage symptoms:
Initiate drug treatment after/in-combination with behavioural therapy. Generally only consider drug treatment if LUTs are moderate (International Prostate Symptom Score of 8-19) to severe (International Prostate Symptom Score of 20-35).
Response and side effect profiles vary between individuals. It is therefore worth trying at least 3 different preparations if response is limited or side effects are not tolerated.
NICE suggest a review of efficacy and side effects with each drug used, perhaps at 6-12 weeks after initiation.
Referral to a specialist urology service should be considered in the following circumstances:
Specialist assessment and management to include:
Conservative and drug treatment:
See above sections.