LLR Lower Urinary Tract Symptoms (LUTS)

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Category

Threshold Criteria

Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladderurinary sphincterurethra, and, in men, the prostate

LUTS are a common problem. The pathway enables that full investigations required are carried out in primary care to ensure that those who need hospital evaluation on are seen quickly, investigated thoroughly and then, wherever possible, passed back to Primary Care, where the majority of LUTS can be managed safely.

Eligibility

LLR ICB will fund secondary care referral for Lower Urinary Tract Symptoms if the following assessment has been made in primary care
 
Patients need to be referred via the 2 WW pathway if they have
– Raised age related PSA
– A hard irregular prostate
– Significant haematuria
 
Patients with one or more symptoms:
– Frequency
– Nocturia
– Difficulty in passing urine
– Dribbling
 
Initial Consultation
History
– Medical, emotional, physical, psychological, sexual, and social issues
– Review of all current medication (including over the counter and herbal medication)

Exclusion of alternative morbidities
– U&E/ eGFR if you suspect renal impairment
– Fasting blood sugar
– Full blood count
– Dip stick urine test
– IPSS score (patient must complete the “Quality of Life “ section)
– Frequency volume chare to differentiate the type of LUTS
– PSA test

Discussion of PSA test if appropriate and full consultation carried out with patient before undertaking. Postpone PSA test for at least one month after treatment of proven UTI.

Two Week Review
– Review the investigations
– Review frequency volume chart
 
Storage Predominant LUTS
– Symptoms
– Frequency
– Urgency
– Consider
– Supervised bladder training
– Anticholinergic drugs
– Containment products e.g. pads or collecting devices
– External collecting devices (sheath appliances, pubic pressure urinals)
– Indwelling catheterisation
– Referral to the community continence team
 
Voiding – predominant LUTS
Symptoms
– Hesitancy
– Poor Flow

Consider
– Alpha blocker
– 5-alpha reductase inhibitor +/- alpha blocker (review in 3-6 months) if
– Prostate >30g (enlarged)
OR
– PSA >1.4mg/ml
 
For persistent storage symptoms
Consider
– Alpha blocker + anticholinergic
– Intermittent bladder catheterisation
– Where a patient is catheterised urine output must be monitored
– If urine output is > or equal to 200 ml/hr patient will need to be admitted for IV fluid support
 
For patient with other underlying causes identified i.e. obstructive uropathy
Refer to urology
 
Review in 4-6 week
– Improvement in symptoms – Continue treatment
– No improvement of symptoms- Discuss possible surgical options and the risks associated with surgery

Refer to Urology if
– Patient agrees and expresses a preference for surgery
– Bothersome LUTS that does not respond to conservative management or drugs
– Retention continues
– LUTS are complicated by recurrent or persistent UTI
ARP 67 Review Date: 2026

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