You can use your existing Medical Independent, MediLearning or PharmacistCPD account to log in. is Ireland's only investigative medical news website for doctors, healthcare professionals and anyone with an interest in health issues.

Established in 2010, along with its sister publication The Medical Independent, our stated aim is to investigate and analyse the major issues affecting healthcare and the medical profession in Ireland. The Medical Independent has won a number of awards for its investigative journalism, and its stories are frequently picked up by national digital, broadcast and print media. The Medical Independent is published by GreenCross Publishing.

Address: Top Floor, 111 Rathmines Road Lr, Dublin 6

Tel: 353 (01) 441 0024

GreenCross Publishing is owned by Graham Cooke.

The benefits of registering: only registered users:
  • receive the ecCopy two days prior to the printed edition.
  • have automatic access to our free CPD sites.
  • can partake in our online MCQs.
  • can enter our online sports quiz.

Sign up now for ease of access to The Medical Independent, Ireland’s most frequently published medical newspaper, delivering award-winning news and investigative reporting.

Download the new Mindo app for both IOS & Android.

  • Get notified when a story goes live
  • Access Premium Content
  • Read Offline
[the_ad_placement id="main-ldb-public"]
[the_ad_placement id="main-ldb-mobile-public"]

You are reading 1 of 2 free-access articles allowed for 30 days

Male LUTS update

By Dermot - 11th Oct 2018 | 7 views

Lower urinary tract symptoms (LUTS) are a common complaint in adult men with a major impact on quality-of-life and substantial economic burden.

The present <em>EAU Non-neurogenic Male LUTS Guidelines</em> are symptom-orientated and offer practical evidence-based guidance on the assessment and treatment of men aged 40 years or older with various non-neurogenic benign forms of LUTS.

The understanding of the LUT as a functional unit, and the multifactorial aetiology of associated symptoms, means that LUTS now constitute the main focus, rather than the former emphasis on benign prostatic hyperplasia (BPH), and secondary to benign prostatic obstruction (BPO), detrusor overactivity (DO)/overactive bladder (OAB), or nocturnal polyuria in men over 40 years.

<h3><strong>Diagnostic evaluation </strong></h3>

The high prevalence and the underlying multifactorial pathophysiology of male LUTS mean that an accurate assessment of LUTS is critical to provide best evidence-based care.

A practical algorithm has been developed by the EAU for guidance (see Figure 2).

<h3><strong>LUTS management (summary)</strong></h3>

<strong><em>Conservative and pharmacological treatment</em></strong>

Watchful waiting is suitable for mild-to-moderate uncomplicated LUTS. It includes education, reassurance, lifestyle advice, and periodic monitoring.

First choice of therapy is behavioural modification, with or without pharmacological treatment. A flow chart illustrating conservative and pharmacological treatment choices according to evidence-based medicine and patients’ profiles is provided in the guidelines.

<strong><em>Surgical treatment</em></strong>

Prostate surgery is usually required when patients have experienced recurrent or refractory urinary retention, overflow incontinence, recurrent urinary tract infections, bladder stones or diverticula, treatment-resistant macroscopic haematuria due to BPH/BPE, or dilatation of the upper urinary tract due to BPO, with or without renal insufficiency (absolute operation indications, need for surgery). Surgery is usually needed when patients have had insufficient relief in LUTS or post-void residual after conservative or pharmacological treatments (relative operation indications).

The choice of the surgical technique depends on prostate size, comorbidities, ability to undergo anaesthesia, patient’s preference/willingness to accept surgery-associated side effects, etc.

<h3><strong>Nocturia </strong></h3>

In relation to the management of nocturia in male LUTS patients, the guidelines state that assessment must establish whether the patient has polyuria, LUTS, sleep disorder or a combination. Therapy may be driven by the bother it causes, but non-bothersome nocturia may warrant assessment of a frequency volume chart (FVC), depending on history and clinical examination, since potential presence of a serious underlying medical condition must be considered.

<h3><strong>Follow-up </strong></h3>

EAU guidelines recommended male LUTS patients follow-up strategy:

Patients with watchful waiting should be reviewed at six months and then annually, provided symptoms do not deteriorate or absolute indications develop for surgical treatment.

Patients receiving beta-1-blockers, muscarinic receptor antagonists, beta-3 agonists, phosphodiesterase-5 inhibitors, or a combination should be reviewed four-to-six weeks after drug initiation. If patients gain symptomatic relief without troublesome side-effects, drug therapy may be continued. Patients should be reviewed at six months and then annually, provided symptoms do not deteriorate or absolute indications develop for surgical treatment.

Patients receiving 5α-reductase inhibitors should be reviewed after 12 weeks and six months to determine their response and adverse events.

Patients receiving desmopressin: Serum sodium concentration should be measured at day three and seven and after one month and, if serum sodium concentration has remained normal, every three months subsequently; the follow-up sequence should be restarted after dose escalation.

Patients after prostate surgery should be reviewed four-to-six weeks after catheter removal to evaluate treatment response and side effects. If patients have symptomatic relief and there are no side effects, further assessment is not necessary.

The <em>Non-neurogenic Male LUTS Guidelines</em> can be accessed at the EAU website at <a href=””></a>.

Leave a Reply

[the_ad_placement id="main-ldb-public-2"]
[the_ad_placement id="main-ldb-mobile-public-2"]
Latest Issue
The Medical Independent – 24 June 2021

You need to be logged in to access this content. Please login or sign up using the links below.

[the_ad_placement id="main-mpu-public"]
Most Read
[the_ad_placement id="main-ldb-public-2"]
[the_ad_placement id="main-ldb-mobile-public-2"]