Initial non-specialist assessment of lower urinary tract symptoms (LUTS) in men

Initial assessment refers to assessment carried out in any setting by a healthcare professional without specific training in managing LUTS in men

• at initial assessment,
  • offer men with LUTS an assessment of their general medical history to identify possible causes of LUTS, and associated comorbidities
  • review current medication, including herbal and over-the-counter medicines, to identify drugs that may be contributing to the problem
    
    
• at initial assessment, offer men with LUTS a physical examination guided by urological symptoms and other medical conditions, an examination of the abdomen and external genitalia, and a digital rectal examination (DRE)
  
  
• at initial assessment, ask men with bothersome LUTS to complete a urinary frequency volume chart
  
  
• offer men with LUTS a urine dipstick test to detect blood, glucose, protein, leucocytes and nitrites
  
  
• at initial assessment, offer men with LUTS information, advice and time to decide if they wish to have prostate specific antigen (PSA) testing if:
  • their LUTS are suggestive of bladder outlet obstruction secondary to BPE or
  • their prostate feels abnormal on DRE or
  • they are concerned about prostate cancer
    
    
• at initial assessment, offer men with LUTS a serum creatinine test (plus estimated glomerular filtration rate [eGFR] calculation) only if you suspect renal impairment (for example, the man has a palpable bladder, nocturnal enuresis, recurrent urinary tract infections or a history of renal stones)
  
  
• cystoscopy should not be routinely offered to men with uncomplicated LUTS (that is, without evidence of bladder abnormality) at initial assessment
  
  
• imaging of the upper urinary tract to men should not be routinely offered with uncomplicated LUTS at initial assessment
  
  
• flow-rate measurement to men with LUTS should not be routinely offered at initial assessment
  
  
• a post void residual volume measurement to men with LUTS should not be routinely offered at initial assessment
  
  
• at initial assessment, give reassurance, offer advice on lifestyle interventions (for example, fluid intake) and information on their condition to men whose LUTS are not bothersome or complicated. Offer review if symptoms change
  
  
• offer men referral for specialist assessment if they have bothersome LUTS that have not responded to conservative management or drug treatment
  
  
• refer men for specialist assessment if they have LUTS complicated by recurrent or persistent urinary tract infection, retention, renal impairment that is suspected to be caused by lower urinary tract dysfunction, or suspected urological cancer
  
  
• offer men considering any treatment for LUTS an assessment of their baseline symptoms with a validated symptom score (for example, the IPSS) to allow assessment of subsequent symptom change

Reference:

• 1) NICE (June 2015). Lower urinary tract symptoms The management of lower urinary tract symptoms in men