The alternative name used to refer to LUTS is the term used to describe a number of symptoms associated with malfunctioning of the bladder and urethra. Any person can experience these symptoms, but it is particularly common among aging men. LUTS is estimated to be present in over 50 percent of males older than 50 years. In the following discussion, the causes for the development of this disease, signs and symptoms, and treatment for this ailment will be elaborated, with detailed concentration on Urolift treatment alternative for LUTS.
Etiology
In older males, the cause of this symptom often stems from BPH: benign prostatic hyperplasia, a noncancerous swelling of the prostate, which may press against the urethra. In females, the most common etiology appears to be lower urinary tract infection. The other causes of LUTS can be:
- Bladder cancer
- Prostate cancer (in males)
- Weakness of detrusor muscles
- Pelvic floor dysfunction
- Chronic prostatitis
- Urethral stricture
- External compression (e.g., pelvic tumor)
- Neurological disease (e.g
Lifestyle factors, such as drinking fluids late at night, consuming excess alcohol and caffeine, and polyuria, which is either caused by diabetes mellitus, too much fluid consumption, or diuretics, may exacerbate or mimic LUTS.
Classification
LUTS have been broadly classified into storage and voiding symptoms.
Storage Symptoms
The storage symptoms result when the bladder should be only storing the urine. LUTS that are storage symptoms include urgency, frequency, nocturia, and urge incontinence.
Voiding Symptoms: They are usually due to the obstruction of the bladder exit. It is difficult to void your urine. The individual experiences symptoms of hesitancy, intermittency, straining, terminal dribbling, and a sensation of incomplete emptying.
Table 1 – Overview of Voiding and Storage Symptoms
Voiding Storage
Hesitancy or straining in micturition Increased urinary frequency
Poor flow (<10mL/s) Nocturia
Terminal dribble Increased sense of urgency to pass urine
Feeling of incomplete emptying The patient has urge incontinence
Clinical Features
The symptoms of LUTS must be, however, clarified to reach a definite diagnosis. Symptoms usually point in the main direction in the irritative spectrum, towards voiding, or in the obstructing direction, towards storage. Associated symptoms include the visibility of blood in the urine, suprapubic discomfort, and the aspect of colicky pain. Since medications such as anticholinergics, antihistamines, and bronchodilators can also exacerbate the LUTS, the history of medication should also be taken.
A digital rectal examination and/or examination of the external genitalia may be helpful, depending on the presentation. The International Prostate Symptom Score (IPSS) can be a useful tool for assessing and monitoring the impact of LUTS on the quality of life in men.
Investigations
Initial Investigations
Post-void bladder scanning, as well as the measurement of flow rate, can help distinguish between the different causes of LUTS and quantify the severity of the condition in those patients presenting with voiding symptoms. A urine diary can indicate patterns in behavior that contribute to the symptoms.
First-line tests include urinalysis for the detection of UTIs, hematuria (e.g., stones), and glycosuria (e.g., diabetes mellitus). Routine blood tests are useful, and a full blood count and urea and electrolytes help as a baseline assessment, especially if there is a clinical suspicion of renal impairment or infection. Prostate-specific antigen (PSA) may be useful in a clinical suspicion of prostatic pathology.
Specialist Investigations
Where appropriate, urodynamic studies can be performed, allowing detailed measurement of both the flow rate, detrusor pressure as well as storage capacity. These are especially necessary in women who have experienced a failure of medical treatment for overactive bladder or stress urinary incontinence and who are being considered for more invasive treatment. Gold standard investigation for assessment of the lower urinary tract is cystoscopy and may be offered where clinically indicated including a history of recurrent infection, or the presence of hematuria. Imaging of the upper urinary tract, ultrasound, or CT scan may be useful with a history of chronic retention, recurrent infections, hematuria as well as radiologically identified lesions.
Conservative Management
Initial management focuses on treating the underlying cause of LUTS. However, several conservative measures can be helpful while the underlying cause is being investigated:
- Fluid Intake: Regulate both timing and volume of intake and avoid excessive caffeine and alcohol intake in the evening.
- Urethral Milking Techniques: These are helpful in men who complain of significant post-micturition dribble.
- Double Voiding: A pass of urine immediately followed by a further attempt to urinate to help complete emptying of the bladder.
- Pelvic Floor Exercises: Strengthening of pelvic floor muscles may be beneficial in stress incontinence or post-micturition dribble.
Bladder Training Techniques: Prolongation of time from having the urge to void to the act of actual urination, which can be helpful under supervision in patients with overactive bladder.
Pharmacological Management
In case of inadequate response to conservative measures, the following pharmacological therapies may be offered:
Anticholinergics (e.g., oxybutynin, tolterodine) inhibit the detrusor muscle to help control overactive bladder.
Mirabegron, a β3 adrenergic agonist, also helps the management of overactive bladder.
Alpha Blockers (e.g., alfuzosin, tamsulosin) and/or 5α-Reductase Inhibitors (e.g., finasteride) reduce prostate size and relax prostatic muscle in BPH.
Loop Diuretics (e.g., furosemide, bumet.
Desmopressin reduces night-time voiding though unlincensed for nocturia
Urolift Procedure
Urolift is the form of an outpatient minimally procedure for treating LUTS due to BPH. The procedure uses tiny implants to keep obturating prostate issue from blocking the urethra, hindering the free flow of urine.
Advantages of Urolift:
The procedure is minimally-invasive as no cutting, heating, nor removal of the prostate tissues are carried out.
- Quick Recovery: Most patients are expected to return to their routine activities in a couple of days post the procedure.
- Preservation of Sexual Function: Sexual side effects are much less with Urolift, when compared to the other surgical treatments for BPH.
- Relief of Symptoms: Most men have quick and significant relief in their symptoms post the procedure.
Who should get Urolift:
Men suffering from BPH and moderate to severe LUTS.
Patients requiring a minimally invasive procedure and those for whom more invasive surgery is not feasible
Patients who are nonresponsive to medications for BPH or cannot tolerate them
Procedural Summary
- Preparation: The patient is given local anesthesia or light sedation.
- Implant placement: The Urolift device is delivered through the urethra, and tiny implants are placed to lift and hold the enlarged prostate tissue from the way of the urethra.
- Completion: The instrument is then withdrawn, and the implants stay back to maintain the patency of the urethra.
Post-Procedure Care:
- Follow-Up: Patients are kept under observation for the resolution of symptoms and complications forth.
- Recovery: Most patients revert to normal activities within a couple of days. Maximum recovery occurs usually within two weeks.
Complications
Patients with LUTS, especially those with residual post-micturition, are at higher chances of the following complications:
- Infection: Stagnant urine serves as an excellent medium for UTI.
- Bladder and Renal Calculi: Chronic urine retention can have as a consequence the formation of bladder and renal stones.
- Changes in the Bladder Wall: Detention with chronic obstruction can lead to hypertrophy of the bladder wall muscle or dilatation, which may cause overflow incontinence.
- Complications of Renal: The retention can progress to renal failure and bilateral hydronephrosis. Acute
- Urinary Retention: It can be caused by the progressive BPH in patients.
Lower urinary tract symptoms represent a problem of high prevalence in both sexes, but with the maximum prevalence in older men, as a consequence of benign prostatic hyperplasia. Proper diagnosis and symptom classification into the storage and voiding categories are crucial in defining the etiology and further treatment.
The treatment options vary and may involve conservative measures, pharmacological therapies, to invasive procedures such as Urolift. Therefore, given the fact, Urolift has come up as a minimally invasive solution to men affected by BPH. It offers significant symptomatic relief with a rapid recovery period and very minimal side effects.
Such continued research and development of innovative treatments, like Urolift, offer hope of improved QOLs for those suffering from LUTS. Understanding these causes and treatments ensures that in most of the cases, it has been easy for healthcare providers to appreciate and tailor their approach to each patient to ensure perfect outcomes.
Lower urinary tract symptoms remain an age-old health concern, particularly for men. An understanding of etiology, classification, and therapeutic efforts at the root level, therefore, is inherent to any form of effective management. UroLift offers a promising and minimally invasive treatment option—thus opening pores for all those shackled in the devastating grip of this condition, greatly improving quality of life.
