Leeds Lower Urinary Tract Symptoms (Adult Male)

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1 Background Information / Scope of Pathway

Quick info:
This pathway has been developed jointly by the Leeds CCG planned care leads, Continence Urology and Colorectal Service (CUCS)
and consultants from Urology, Urogynaecology and Elderly Medicine within LTHT.

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2 Information Resources for Patients and Carers

Quick info:
Patient Information Leaflets:
Community Urology and Colorectal Service (CUCS) - Patient Information Leaflet
Male Lower Urinary Tract Symptoms (LUTS) - Patient Information Leaflet
Bladder Re-Training Patient Information Leaflet
Bladder Diary
Self Assessment
Pelvic Floor Exercises for Men - Patient Information Leaflet
PSA - Patient Information Leaflet
Nocturnal Polyuria

Additional Resources:
International Prostate Symptom Score (IPSS)
The Management of Lower Urinary Tract Symptoms in Men - NICE guidelines

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3 Development and Updates to this Pathway

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Developed November 2014

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4 Referral Forms

Quick info:
Continence, Urology and Colorectal Service (CUCS) Referral Form

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6 History, examination and Investigations

Quick info:
GP Information:

At initial assessment GP should perform the following :
Counselling re PSA Examination:

  • Abdominal
  • DRE

Investigations:

  • Urinalysis
  • Bloods - U+E, RBS, PSA

If LUTS is suspected calculate International Prostate Symptom Score (IPSS) to establish severity.
Mild LUTS - score 0-7
Moderate LUTS -score 8-19
Severe LUTS - score 20-35

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7 Red Flags 2 Week Wait Urology Referral

Quick info:

  • Haematuria
  • Malignant prostate on examination
  • Raised PSA see appropriate pathway
  • Suspected urological cancer

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8 Mild LUTS IPSS Score 0-7

Quick info:
GP Information:
IPSS Score 0-7
IPSS Scoring System
The Management of Lower Urinary Tract Symptoms in Men - NICE guidelines

Patient Information:
Offer advice and provide information on bladder training and fluid management
Bladder Re-Training Patient Information Leaflet

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9 Moderate LUTS IPSS Score 8-19

Quick info:
GP Information:
IPSS Score 8-19
IPSS Scoring System
The Management of Lower Urinary Tract Symptoms in Men - NICE guidelines

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10 Severe LUTS (IPSS 20-35) Refer to Urologist

Quick info:
GP Information:
IPSS Score 20-35
IPSS Scoring System
The Management of Lower Urinary Tract Symptoms in Men - NICE guidelines

Offer to refer men for specialist assessment if they have bothersome LUTS that have not responded to conservative management or drug treatment
Refer men for specialist assessment if they have:

  • LUTS complicated by recurrent or persistent urinary tract infection or
  • retention or
  • renal impairment you suspect is caused by lower urinary tract dysfunction or
  • stress urinary incontinence.

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12 Lifestyle advice Patient Information Leaflet

Quick info:

Patient Information:
Bladder Re-Training Patient Information Leaflet

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13 Trial of Medication

Quick info:
Try anticholinergic for 3 months. Alpha blocker first line for 3 months
If no improvement add 5-alpha reductase inhibitor - 3 months
If still no improvement refer to Continence, Urology and Colorectal Service (CUCS)

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14 Refer Continence, Urology and Colorectal Service (CUCS)

Quick info:
Continence, Urology and Colorectal Service (CUCS)

Continence, Urology and Colorectal Service (CUCS) Referral Form
CUCS service will assess and treat and refer patient on to secondary care when necessary

CUCS Contact Information
Telephone: (0113) 30 55138
Fax: (0113) 30 55108
Email: info.cucs@nhs.net

Key Dates

Published: 21-Nov-2014, by Leeds
Valid until: 31-Aug-2017

References

This is a list of all the references that have passed critical appraisal for use in the care map Urology - Male lower urinary tract symptoms

  1. National Institute for Health and Clinical Excellence (NICE). Male lower urinary tract symptoms. Clinical guideline 97. London: NICE; 2010.
    http://www.nice.org.uk/nicemedia/live/12984/48554/48554.pdf
  2. Clinical Knowledge Summaries (CKS). Lower urinary tract symptoms in men, age-related (prostatism).
    Newcastle upon Tyne: CKS; 2010.
  3. Clinical Knowledge Summaries (CKS). Prostatitis - acute. Newcastle upon Tyne: CKS; 2009.
  4. Clinical Knowledge Summaries (CKS). Prostatitis - chronic. Version 1.0. Newcastle upon Tyne: CKS; 2009.
  5. British Association of Urological Surgeons (BAUS). Diagnosis of lower urinary tract symptoms resulting from benign prostatic hyperplasia. London: BAUS; 2012. http://www.baus.org.uk/Resources/BAUS/Documents/PDF%20Documents/BAUS%20in%20general/Inn ovAiT-2012-Kirby-innovait_ins114.pdf
  6. Contributors invited by Map of Medicine. 2010.
  7. Practice-informed recommendations, including contributors representing the Royal College of General
    Practitioners. 2013.
  8. Oelke M, Bachmann A, Descazeaud A et al. Guidelines on the management of male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Arnhem: EAU; 2013. http://www.uroweb.org/gls/pdf/13_Male_LUTS_LR.pdf
  9. Renal Association, British Association of Urological Surgeons (BAUS). Joint consensus statement on the initial assessment of haematuria. London: BAUS; 2008. http://www.baus.org.uk/AboutBAUS/publications/haematuria-guidelines
  10. National Institute for Health and Clinical Excellence (NICE). Referral guidelines for suspected cancer.
    Clinical guideline 27. London: NICE; 2005. http://www.nice.org.uk/nicemedia/live/10968/29814/29814.pdf
  11. National Institute for Health and Care Excellence (NICE). Mirabegron for treating symptoms of overactive bladder. London: NICE; 2013.
    http://www.nice.org.uk/nicemedia/live/14195/64256/64256.pdf