Lower urinary tract symptoms (LUTS) are very common. It is important to distinguish between storage related LUTS (ie: overactive bladder) and voiding related LUTS (ie: outlet obstruction).
The following baseline investigations are recommended:
- Renal tract US (including post void residual and prostate size in men)
- Urine MCS
- Urine cytology
- PSA (in men)
- IPSS questionnaire
If a patient has storage related symptoms (frequency, urgency) a trial of anticholinergic is reasonable. If a male patient has voiding related symptoms (weak stream, straining to void, dribbling, hesitancy, incomplete emptying) a trial of alpha-blocker such as tamsulosin (Flomaxtra), or silodosin (Urorec) prior to their appointment would be reasonable providing there are no contraindications (eg upcoming cataract surgery, postural hypotension). If the patient is over the age of 70yrs the combination of tamsulosin and dutasteride (Duodart) can be trialled. This medication is on the PBS.
A patient requires urgent management/treatment if they have a high post void residual in the setting of renal impairment or hydronephrosis.