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 (+ prostate size in men))
- Urine MCS
- Urine cytology
- PSA (in men)
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) prior to their appointment would be reasonable providing there are no contraindications (eg upcoming cataract surgery, postural hypotension).
A patient requires urgent management/treatment if they have a high post void residual in the setting of renal impairment or hydronephrosis.