What is LUTS (Lower Urinary Tract Symptoms)?

Understanding Lower Urinary Tract Symptoms (LUTS)

Lower urinary tract symptoms (LUTS) are a collection of storage and/or voiding disturbances affecting the bladder, bladder neck, prostate, distal sphincter mechanism, and urethra, which are common in aging men and can significantly impact quality of life. 1

Definition and Classification

LUTS are divided into two main categories:

• Storage symptoms: Experienced during the bladder filling phase, including:

  • Daytime frequency (voiding too often during the day)
  • Nocturia (waking up at night to urinate)
  • Urgency (sudden compelling desire to pass urine)
  • Urge incontinence (leakage associated with urgency) 1, 2

• Voiding symptoms: Experienced during the voiding phase, including:

  • Slow stream
  • Splitting or spraying of urinary stream
  • Intermittency (flow stops and starts)
  • Hesitancy (difficulty initiating urination)
  • Straining
  • Terminal dribble 1, 2

• Post-micturition symptoms: Experienced immediately after urination:

  • Feeling of incomplete emptying
  • Post-micturition dribble 2

Etiology

LUTS may result from multiple causes:

• Structural or functional abnormalities in the lower urinary tract 1
• Neurological disorders affecting peripheral and/or central nervous systems that control the lower urinary tract 1
• Secondary conditions including cardiovascular, respiratory, or renal dysfunction 1
• Prostatic conditions such as benign prostatic hyperplasia (BPH), benign prostatic enlargement (BPE), or benign prostatic obstruction (BPO) 1
• Overactive bladder syndrome characterized by urgency with or without urgency incontinence, usually with frequency and nocturia 1
• Tissue fibrosis in the lower urinary tract, which is increasingly recognized as a contributing factor 3

Terminology Clarification

It's important to note that terms such as "BPH patient," "symptomatic BPH," "clinical BPH," "drugs for BPH," and "BPH treatment" are considered imprecise and not recommended in clinical practice. 1

• Benign prostatic hyperplasia (BPH) should be reserved only for the histological pattern it describes 1
• Benign prostatic enlargement (BPE) refers to gland enlargement based on size assessment 1
• Benign prostatic obstruction (BPO) indicates obstruction proven by pressure flow studies or highly suspected from flow rates in an enlarged gland 1
• Bladder outlet obstruction (BOO) is the generic term for all forms of obstruction to the bladder outlet 1

Clinical Significance

LUTS are often bothersome and can significantly impact quality of life. They are associated with:

• Decreased quality of life 1, 4
• Sleep disturbances, particularly with nocturia 4
• Increased economic burden for patients and healthcare systems 1
• Risk of complications if left untreated, including urinary retention, recurrent UTIs, bladder calculi, and renal impairment 3

Research indicates that patients with nocturia report significantly higher impact on their quality of life compared to those with daytime LUTS only, with sleep disruption being a major contributor to this burden. 4