Lower urinary tract symptoms or ‘prostatism’

 In both sexes nonspecific symptoms of bladder dysfunction become more common with ageing, probably owing to  impairment of smooth muscle function and neurovesical coordination. Not all symptoms of disturbed voiding in ageing men should therefore be attributed to BPH causing BOO. Many urologists prefer the term ‘lower urinary tract symptoms’ (LUTS).

The following conditions can coexist with BOO, leading to difficulty in diagnosis and in predicting the outcome of treatment:

(a) idiopathic detrusor instability (see Chapter 65);

(b) neuropathic bladder dysfunction as a result of strokes, Alzheimer’s disease or Parkinson’s disease (see Chapter 65);

(c)degeneration of bladder smooth muscle giving rise to impaired voiding and detrusor instability;

(d)BOO due to BPH.

Symptoms of ‘prostatism or lower urinary tract symptoms (LUTS)

  Obstructive                                              Irritative
 
Hesitancy (worsened if the bladder is        Frequency
  very full)                                                   Nocturia
  Poor flow (unimproved by straining)          Urgency
  Intermittent stream — stops and starts       Urge incontinence
  Dribbling (including after micturition)          Nocturnal incontinence
  Sensation of poor bladder emptying          (enuresis)

Episodes of near retention

The symptoms of prostatism are now usually assessed by means of scoring systems which give a semiobjective measure of severity. However, some symptoms do not give an accurate picture of the underlying pathophysiological problem. For instance, a man with severe detrusor instability may only void small volumes and hence he will have a sensation of poor flow because low voided volumes (<100 ml) are associated with low flow rates.

Severe irritative symptoms are usually associated with detrusor instability. Postmicturition dribbling is now realized not to be a consequence of bladder outflow obstruction and is usually not improved by prostatectomy.