Lower Urinary Tract Symptoms and BPH

Lower urinary tract symptoms, or LUTS, can affect both men and women, but only men experience LUTS due to benign prostatic hyperplasia, or BPH. As it relates to BPH, LUTS consists of many urinary tract issues caused by an ever-expanding prostate gland. Typically experienced by men over the age of 40, BPH-induced lower urinary tract symptoms are progressive and become more prevalent as a man ages. Roughly 50% of men will be diagnosed with BPH or an enlarged prostate by the time they reach their 50s, and up to 80% of men will eventually experience BPH as they reach their 80s.¹ However, of this 50% of men in their 50s who are diagnosed with BPH, only about half will realize lower urinary tract symptoms. The other half won’t experience any symptoms. Benign prostatic hyperplasia and LUTS can present as an overactive bladder, a urinary tract infection, urinary incontinence, low urine flow, bladder voiding problems, starting and stopping, urgency, and a host of other urinary issues. If LUTS are suspected, it’s important to make an appointment with a urologist or a primary care physician to get a diagnosis and develop a plan to address the urinary symptoms promptly so life again becomes more enjoyable and any mental health issues surrounding the potentially life-changing BPH symptoms can be addressed. Urinary symptoms associated with LUTS, brought on by benign prostatic hyperplasia, are typically caused by the crowding or pinching of the urethra or urinary tract by the growing prostate. For some men, both the urethra and bladder get crowded out by the prostate as it enlarges. Each year a man ages, the growing prostate can put more pressure on these organs and cause more issues. Lower urinary tract symptoms, which were once a minor inconvenience, can become life-altering or life-threatening if the prostate is allowed to grow too large or grow in an increasingly obstructive manner.

Assessment and Evaluation of Lower Urinary Tract Symptoms

The assessment and evaluation of Benign Prostatic Hyperplasia, or BPH,-induced lower urinary tract symptoms, or LUTS, considers a man’s urologic complaints in an attempt to pinpoint underlying causes so an in-depth evaluation and subsequent treatment plan can be formed. Benign prostatic hyperplasia can be an annoying disease that tends to worsen over time in many men if not sufficiently addressed. LUTS can include a wide range of symptoms that can involve the urethra, bladder, and surrounding tissue. A LUTS assessment will typically include the following information and steps: 1) Medical History: A detailed medical history, including age, type of symptoms, symptom duration, and how symptoms present themselves will allow an assessment to progress to the next steps, which include:

• Voiding symptoms: Urination frequency, urgency (the need to suddenly urinate), hesitancy (trouble starting urination), nocturia (needing to urinate multiple times at night), weak urine stream, intermittency (starting and stopping urination) and dribbling after urinating.
• Storage symptoms: Urinary incontinence (accidental urine leakage), urgency, and nocturia are all bladder storage issues.
• Pain or discomfort: Pain or discomfort while urinating or in the lower abdomen, side, back, or pelvic areas.
• Hematuria: Blood in the urine
• Relevant medical history: Kidney stones, urinary tract infections (UTIs), prostatitis, family history of prostate issues, overactive bladder, urinary symptoms increasing when taking cold or sinus medicine, diabetes, current medications, and any other relevant medical history.

2) Physical Exam: A complete and thorough physical exam should be performed that includes an abdominal examination and a digital rectal exam (DRE) to determine the prostate’s general size, consistency and to check for any bumps or lumps which could signify cancer. 3) Urinalysis: A standard urinalysis is important to determine if any signs of infection, blood, kidney disease or any other abnormalities are present in the urine. 4) Post-void Residual (PVR) Volume: This urine volume test utilizes specialized instruments to measure whether the bladder is emptying fully after urination or if it is having trouble. High PVR volumes could indicate that the bladder is having difficulty emptying its contents completely. 5) Uroflowmetry: Utilizing a unique device that fits in a toilet and measures urine flow volume and rate during urination, this test can help assess the strength and duration of the urinary stream. 6) Cystoscopy: When additional evaluation is needed to more definitively determine if BPH is present, a thin, flexible tube with a camera (cystoscope) on the end can be inserted into the urethra and up into the bladder to visualize any obstructions or prostate encroachment on the urethra. 7) Imaging: Based on clinical findings and specific symptoms, imaging tests such as an ultrasound, MRI, or a CT scan may be requested to more definitively assess the urinary tract, bladder and surrounding structures to determine if BPH is present. 8) Specialized Testing: More testing may be necessary based on findings from previous assessments or if specific conditions warrant. These tests may include additional urodynamic testing, a PSA test, or additional testing needed to make a BPH determination. 9) Assessment Tools: Questionnaires are utilized to help quantify and assess the impact of LUTS on lifestyle. These questionnaires include the International Prostate Symptom Score (IPSS). With the assistance of specialized testing and assessment tools available to the urologist or healthcare provider, an accurate benign prostatic hyperplasia diagnosis can be made along with recommendations for management and possible treatment, including lifestyle modifications, medications, or surgery, depending upon the cause and severity of the lower urinary tract symptoms.

Management of LUTS

When a diagnosis of BPH-caused lower urinary tract symptoms is determined, the next step is to begin managing the various LUTS. There are generally three ways in which men address their LUTS, depending on their severity and the impact those symptoms have on their daily life. This includes watchful waiting with lifestyle changes, medication, and minimally invasive procedures. 1) Lifestyle Modifications: When benign prostatic hyperplasia and its associated lower urinary tract symptoms are mild, some men opt for watchful waiting while simply managing any minor symptoms with lifestyle modifications until symptoms improve or until it is decided to take the next step to improve worsening symptoms. 2) Medications: There are two types of BPH medications that either help shrink the prostate (5-alpha-reductase inhibitors) or simply help manage lower urinary tract symptoms caused by BPH (alpha-blockers). There are side effects to taking either one, but some men find them useful in addressing their BPH symptoms. 3) Minimally Invasive Procedures: Many good minimally invasive BPH procedures are available that will address lower urinary tract symptoms brought on by BPH, and that can handle most prostate sizes. If watchful waiting or medications aren’t working or aren’t preferred, many men will opt for a more definitive way to eliminate BPH and the lower urinary tract symptoms associated with it. Many of these procedures work well for men with prostate sizes between 30-100 grams. It is important to assess and evaluate any lower urinary tract symptoms to determine the cause. Typically, men over the age of 40 experience these urinary symptoms due to benign prostatic hyperplasia, or BPH, but they can also be caused by a urinary tract infection, prostate inflammation (prostatitis), detrusor muscle weakness or overactivity, prostate cancer, or neurological disease.² Once a BPH determination is made, it is advantageous to begin addressing LUTS since early intervention can stave off an even larger prostate and worse symptoms down the road. Watchful waiting with possible lifestyle adjustments, medication, and minimally invasive surgery are all options that men choose, depending upon the severity of symptoms and how their everyday life is affected. The earlier BPH and LUTS can be assessed, evaluated, diagnosed, and managed, the more treatment options are available.   References

1. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
2. https://www.ncbi.nlm.nih.gov/books/NBK553261/#:~:text=Other%20conditions%20that%20can%20cause,management%20of%20LUTS%20in%20men

Important Safety Information

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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