When to investigate lower urinary tract symptoms for possible urological conditi

Investigations for lower urinary tract symptoms (LUTS) should be performed when symptoms are bothersome, complicated, or do not respond to initial conservative management. Specifically, men should be referred for specialist assessment and investigations if they have:

• Bothersome LUTS not responding to conservative or drug treatment.
• LUTS complicated by recurrent or persistent urinary tract infection, urinary retention, suspected renal impairment due to lower urinary tract dysfunction, or suspected urological cancer.

At specialist assessment, investigations should be guided by clinical indications:

• Offer measurement of flow rate and post-void residual volume.
• Offer imaging of the upper urinary tract only if clinically indicated, such as in cases of chronic retention, haematuria, recurrent infection, sterile pyuria, profound symptoms, or pain.
• Consider cystoscopy if there is a history of recurrent infection, sterile pyuria, haematuria, profound symptoms, or pain.
• Carry out serum creatinine testing and upper tract imaging in men with chronic urinary retention (residual volume >1 litre or palpable bladder).

Routine investigations such as imaging of the upper urinary tract, flow-rate measurement, and post-void residual volume measurement are not recommended at initial assessment in uncomplicated LUTS.