Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To differentiate between benign prostatic hyperplasia (BPH) and other potential causes of lower urinary tract symptoms (LUTS) in men, a structured assessment is undertaken, focusing on excluding serious underlying conditions NICE CKS.
- Initial Assessment (General Practice):
- A comprehensive general medical history is taken to identify possible causes of LUTS and any associated comorbidities NICE CG97.
- Current medications, including herbal and over-the-counter remedies, are reviewed as they may contribute to LUTS NICE CG97.
- A physical examination is performed, including examination of the abdomen, external genitalia, and a digital rectal examination (DRE) NICE CG97.
- Men with bothersome LUTS are asked to complete a urinary frequency volume chart NICE CG97.
- A urine dipstick test is offered to detect blood, glucose, protein, leucocytes, and nitrites, which can indicate infection or other issues NICE CG97.
- Prostate-specific antigen (PSA) testing is offered if LUTS suggest bladder outlet obstruction secondary to BPH, if the prostate feels abnormal on DRE, or if the man is concerned about prostate cancer NICE CG97. Suspected prostate cancer is managed according to NICE guidelines NICE CG97.
- A serum creatinine test (with eGFR calculation) is only offered if renal impairment is suspected, for example, with a palpable bladder, nocturnal enuresis, recurrent urinary tract infections, or a history of renal stones NICE CG97.
- Routine cystoscopy, upper urinary tract imaging, flow-rate measurement, or post-void residual volume measurement are generally not offered at initial assessment for uncomplicated LUTS NICE CG97.
- Referral for Specialist Assessment:
- Men are referred for specialist assessment if their bothersome LUTS have not responded to conservative management or drug treatment NICE CG97.
- Referral is also necessary if LUTS are complicated by recurrent or persistent urinary tract infection, retention, suspected renal impairment caused by lower urinary tract dysfunction, or suspected urological cancer NICE CG97.
- Specialist Assessment:
- At specialist assessment, a general medical history, medication review, and physical examination (including DRE) are repeated NICE CG97.
- A urinary frequency volume chart is completed NICE CG97.
- PSA testing is offered under the same criteria as initial assessment NICE CG97.
- Measurement of flow rate and post-void residual volume are offered NICE CG97.
- Cystoscopy is only performed when clinically indicated, such as with a history of recurrent infection, sterile pyuria, haematuria, profound symptoms, or pain NICE CG97.
- For men with chronic urinary retention (residual volume greater than 1 litre or a palpable bladder), a serum creatinine test and imaging of the upper urinary tract are carried out NICE CG97.