Investigation and treatment of lower urinary tract dysfunction

Abstract

Recognition of the prevalence and distress caused by bladder symptoms has resulted in far greater emphasis on the assessment and treatment of bladder problems in primary and secondary care. Media attention to new and innovative treatments of urinary incontinence has educated both patients and doctors alike. Increasingly, patients armed with newspaper cuttings and internet printouts are likely to enter the surgery to discuss the previously taboo subject of their urinary problems. Lower urinary tract symptoms are common amongst women of all ages and a significant cause of quality of life impairment. Patients normally present with symptoms of bladder overactivity and/or stress incontinence. A thorough clinical assessment will identify those patients for whom treatment in primary care is appropriate and those for whom specialist referral should be made. The majority of patients can be managed in primary care without the need for complex investigations and treatment. Conservative therapies require both motivated patients and trained therapists to be maximally effective. Significant advances have been made in the pharmacotherapy of overactive bladder and the surgical treatment of genuine stress incontinence. Although it may not be possible to cure everyone of their urinary symptoms the majority of patients can be significantly improved.