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This guidance covers the diagnosis and management of males over 18 years, with male lower urinary tract symptoms (LUTS) − storage, voiding, and post-micturition − across primary and secondary care.
Red Flag/urgently refer patients if:
Pre-choice Triage is currently active for this specialty.
Storage symptoms:
Voiding symptoms:
Post-micturition symptoms:
Consider asking the patient to complete a voiding diary chart, especially in the assessment of nocturia or suspected overactive bladder.
All patients should have:
Use urine dipsticks to identify:
Some patients should have:
Prostate specific antigen (PSA) with appropriate counselling:
For Non-bothersome symptoms:
Provide the following for men presenting with lower urinary tract symptoms (LUTS) which are not bothersome or complicated:
For Bothersome voiding symptoms:
Lower urinary tract symptoms (LUTS) that are troublesome and have an impact on quality of life (QoL)
Mild symptoms - International Prostate Symptom Score (IPSS) score 0-7
Moderate 8-19
Severe greater than 19
Consider alpha blockers & referral to Urology
For Bothersome Storage symptoms:
If predominantly storage symptoms (confirm with frequency volume chart)
For Post-micturition symptoms:
Post-void milking:
If milking is ineffective a referral to Urology is unlikely to add benefit for the patient. In this instance containment products might be considered.
Refer to Urology
Please include in referral letter the following results from investigations:
Please note these referrals are subject to Pre-choice Triage.
Significant caffeine intake has the potential to cause clinically significant LUTS and should be minimised prior to referral.
e-Referral service selection:
East
This service is not available on e-Referrals
Franklyn Hospital, St Thomas, Exeter EX2 9HS
Tel: 01392 208478
Email to ndht.bladderandbowel@nhs.net
This guideline has been signed off on behalf of NHS Devon.
Publication date: July 2020