Lower urinary tract symptoms revisited

Abstract

In recent years, there has been an increased awareness of the importance of considering lower urinary tract symptoms (LUTS) as a global term. Under this umbrella term, disorders of bladder function can be most effectively considered as failure to store or failure to empty. We now clearly recognise the misconceptions inherent in the assumptions that all LUTS in men are caused by benign prostatic obstruction (BPO) and that overactive bladder (OAB) is a female disease [1]. In this context, it is important to recognise that it has been known for at least 4 decades that symptoms do not relate to the underlying pathophysiology in many patients; indeed, the phrase ‘‘the bladder is an unreliable witness’’ was coined to acknowledge this [2]. We also recognise that it is essential to take into account patients’ expectations and goals to achieve the most successful outcome for therapy. To adequately manage LUTS, it is important not only to consider the integrated functional unit of the lower urinary tract but, at the same time, to reflect on the influence of pathophysiology arising in other organ systems. In addition to age, a number of studies have reported associations between LUTS and body mass index; waist–hip ratio; alcohol consumption; smoking; and cardiovascular, metabolic, and endocrine factors. By moving beyond a local organocentric view and by taking a more holistic approach, we will clearly be able to manage clinical scenarios more effectively. The term LUTS as suggestive of bladder outflow obstruction due to benign prostatic enlargement secondary to benign prostatic hyperplasia (BPH) was introduced in 1994 to dissociate urinary symptoms in the male from any implied specific site of origin of symptoms, such as the prostate, as previously implied by the term prostatism [3]. This change acknowledged the poor correlation between the voiding symptoms: hesitancy; poor urinary flow and straining to void; prolonged voiding time and postmicturi-