Lower Urinary Tract Symptoms


General

Lower urinary tract symptoms include a variety of symptoms which are non-specific and can result from a number of urologic issues.

  • Lower urinary tract typically refers to the bladder and urethra while the upper urinary tract typically refers to the kidneys and ureters.
  • Typical lower urinary tract symptoms:
    • Frequency

      • Voiding multiple times during a 24hr time frame (typically more than 5-6 times per day and possibly more than 1-2 times at night)
    • Urgency

      • The sudden and immediate need to urinate.
      • In the most severe forms can lead to sudden, uncontrollable incontinence of urine
    • Nocturia

      • Bothersome night-time voiding
    • Dysuria

      • Discomfort or pain associated with urination
      • Discomfort or pain can be at the beginning, during, or at the end of urination
    • Weak stream

      • Low pressure urinary flow
    • Hesitancy

      • Difficulty in starting the flow of urine
    • Intermittency

      • Difficulty in maintaining the urine stream (i.e. intermittent stopping and starting of the stream)
    • Incomplete emptying

      • Retained urine in the bladder following urination.
    • Postvoid dribbling

      • Involuntary loss of a small volume of urine at the tail end of urination.
    • Straining to urinate

      • Bearing down or pushing down to improve urine outflow.

Differential Diagnosis

Infection of the lower urinary tract, Benign Prostatic Hypertropy (BPH), lower urinary tract stricture of the meatus or urethra (i.e. scar tissue which can block urine flow), bladder neck contracture (i.e. scar tissue at the level of the bladder neck which can block urine flow), bladder cancer, prostate cancer, urethral cancer, nonspecific inflammation of the bladder, prostatitis, urethritis, yeast infection, history of radiation to the pelvis, prior surgery (in the urinary tract or pelvic surgery), urinary tract symptoms resulting from neurologic problems (i.e. stroke, parkinson’s disease, multiple sclerosis, diabetes, spinal cord injury, brain trauma, or other neurologic disorder), poorly integrated bladder and urethral sphincter complex (i.e. detrusor sphincter dysenergia), bladder stone or foreign body in the lower urinary tract, bladder diverticulum, urethral diverticulum, or other etiology.


Evaluation

  • Lab tests to evaluate blood count, electrolytes, kidney function, and potentially PSA.
  • Urine tests to evaluate for infection and/or for tumor cells if concerned about any potential malignant etiology
  • In men, digital rectal examination to evaluate the prostate
  • Possible urodynamic investigation to evaluate lower urinary tract function (i.e. allows direct investigation of storage and emptying characteristics of the bladder and urethra complex)
  • Possible cystoscopic examination (i.e. scoping the bladder and urethra for any possible etiology)
  • Possible imaging depending on likely etiology (i.e. ultrasound, CT scan, MRI, or other)


Treatment Options

    • Depends on the etiology found.
Male urinary tract in detail

About Lower Urinary Tract Symptoms

General
Differential Diagnosis
Evaluation
Treatment Options