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

Specialist assessment refers to assessment carried out in any setting by a healthcare professional with specific training in managing LUTS in men (1):

• assess 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
  
  
• offer 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)
  
  
• men with LUTS should be asked to complete a urinary frequency volume chart
  
  
• 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
    
    
• offer men with LUTS measurement of flow rate and post void residual volume
  
  
• cystoscopy to men with LUTS having specialist assessment should on be offered when clinically indicated, for example if there is a history of any of the following:
  • recurrent infection
  • sterile pyuria
  • haematuria
  • profound symptoms
  • pain
    
    
• imaging of the upper urinary tract to men with LUTS having specialist assessment should only be offered when clinically indicated, for example if there is a history of any of the following:
  • chronic retention
  • haematuria
  • recurrent infection
  • sterile pyuria
  • profound symptoms
  • pain
    
    
• multichannel cystometry should be considerd for men with LUTS having specialist assessment if they are considering surgery
  
  
• pad tests to men with LUTS should only be offered if having specialist assessment if the degree of urinary incontinence needs to be measured

Reference:

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