Current Urology Reports

, Volume 13, Issue 6, pp 474–481 | Cite as

Office Evaluation of Male Patients with Lower Urinary Tract Symptoms

  • Shahin Tabatabaei
  • Saman Shafaat Talab
  • Mahdi Zangi
  • Henry H. Woo
Office Urology (N Shore, Section Editor)


Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) are one of the most common urologic disorders in men. Accurate history-taking and focused physical examination allows us to diagnose the majority of cases. A better understanding of risk factors helps us tailor our treatment and predict outcomes more accurately. Population studies are crucial in our understanding of LUTS/BPH natural history. Temporary prostatic urethral stents that are used for the management of urinary retention may also be used for evaluation of patients with detrusor hypo-contractility. The use of ultrasound to measure intravesical prostatic protrusion (IPP) and the Doppler study for prostate capsular artery resistive index are promising. Near-infrared spectroscopy (NIRS) examines the tissue oxygenation that may be affected by bladder outlet obstruction. The mathematical algorithm needs some fine-tuning, and its reproducibility is debatable. Serum and urinary biomarkers may help us to diagnose the disorder, and more effectively monitor patients’ response to therapy. Among all, IPP is clinically more applicable at this time.


Biological markers/blood/urine Lower urinary tract symptoms/diagnosis/etiology Male Middle aged Prostatic hyperplasia/diagnosis Risk factors Spectroscopy, Near-infrared Ultrasonography/standards Urodynamics 



S. Tabatabaei would like to disclose he has received compensation as a consultant for device development from Smith & Nephew and a research grant for treatment of BPH from Ethicon; S. Talab reported no potential conflicts of interest relevant to this article; M. Zangi reported no potential conflicts of interest relevant to this article; H. Woo would like to disclose he has received compensation as a consultant for American Medical Systems.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    • Irwin DE, Kopp ZS, Agatep B, et al. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011;108:1132. Interesting paper estimating the prevanlence voiding dysfunction for present and future.PubMedCrossRefGoogle Scholar
  2. 2.
    • McVary K, Roehrborn C, Avins A, et al. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). American Urological Association. 2010. This American guideline decribes recent recommended diagnosis as well as management procedures for BPH based on available evidence. Google Scholar
  3. 3.
    • Oelke M, Bachmann A, Descazeaud A, et al. Guidelines on the Treatment of Non-neurogenic Male LUTS. European Association of Urology. 2011. Similar to AUA guideline, European guideline is a review of recommended medical as well as surgical treatments for non-neurogenic causes of LUTS including BOO/LUTS, based on evidence and expxert opinions. Google Scholar
  4. 4.
    St Sauver JL, Jacobsen SJ, Jacobson DJ, et al. Statin use and decreased risk of benign prostatic enlargement and lower urinary tract symptoms. BJU Int. 2011;107:443.PubMedCrossRefGoogle Scholar
  5. 5.
    Barry MJ, Fowler Jr FJ, O’Leary MP, et al. Correlation of the American Urological Association symptom index with self-administered versions of the Madsen-Iversen, Boyarsky and Maine Medical Assessment Program symptom indexes. Measurement Committee of the American Urological Association. J Urol. 1992;148:1558.PubMedGoogle Scholar
  6. 6.
    Barry MJ, Fowler Jr FJ, O’Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549.PubMedGoogle Scholar
  7. 7.
    • Abrams P, Chapple C, Khoury S, et al. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009;181:1779. This article underlines assessment of voiding symptoms and QoL for LUTS management.PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson TV, Schoenberg ED, Abbasi A, et al. Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations. J Urol. 2009;181:230.PubMedCrossRefGoogle Scholar
  9. 9.
    • Murray S, Woo H. Validation of patient global ipression of improvement (PGI-I) to assess the aeffectivenes of surgery for bladder outflow obstruction. J Urol. 2011;187:e733, 2012. This abstract proposes validation of a new concept of PGI-I to measure outcome of surgery for Boo/LUTS. Google Scholar
  10. 10.
    Parsons JK, Sarma AV, McVary K, et al. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2009;182:S27.PubMedCrossRefGoogle Scholar
  11. 11.
    • Penson DF, Munro HM, Signorello LB, et al. Obesity, physical activity and lower urinary tract symptoms: results from the Southern Community Cohort Study. J Urol. 2011;186:2316. This community study suggests an association between obesity and LUTS.PubMedCrossRefGoogle Scholar
  12. 12.
    De Nunzio C, Aronson W, Freedland SJ, et al. The correlation between metabolic syndrome and prostatic diseases. Eur Urol. 2012;61:560. Supporting the epidemiologic studies regarding a correlation between prostate diseases and metabolic syndrome.PubMedCrossRefGoogle Scholar
  13. 13.
    Roehrborn CG, Chinn HK, Fulgham PF, et al. The role of transabdominal ultrasound in the preoperative evaluation of patients with benign prostatic hypertrophy. J Urol. 1986;135:1190.PubMedGoogle Scholar
  14. 14.
    Mebust WK, Holtgrewe HL, Cockett AT, et al. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 1989;141:243.PubMedGoogle Scholar
  15. 15.
    Mukamel E, Nissenkorn I, Boner G, et al. Occult progressive renal damage in the elderly male due to benign prostatic hypertrophy. J Am Geriatr Soc. 1979;27:403.PubMedGoogle Scholar
  16. 16.
    Moyer VA. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:120.PubMedGoogle Scholar
  17. 17.
    Djavan B, Zlotta A, Kratzik C, et al. PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/mL. Urology. 1999;54:517.PubMedCrossRefGoogle Scholar
  18. 18.
    • Mao Q, Zheng X, Jia X, et al. Relationships between total/free prostate-specific antigen and prostate volume in Chinese men with biopsy-proven benign prostatic hyperplasia. Int Urol Nephrol. 2009;41:761. This study emphasizes that free PSA more accurately correlates with total prostate volume.Google Scholar
  19. 19.
    Roehrborn CG, Siami P, Barkin J, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57:123.PubMedCrossRefGoogle Scholar
  20. 20.
    Roehrborn CG, Andriole GL, Wilson TH, et al. Effect of dutasteride on prostate biopsy rates and the diagnosis of prostate cancer in men with lower urinary tract symptoms and enlarged prostates in the Combination of Avodart and Tamsulosin trial. Eur Urol. 2011;59:244.PubMedCrossRefGoogle Scholar
  21. 21.
    Corica AP, Larson BT, Sagaz A, et al. A novel temporary prostatic stent for the relief of prostatic urethral obstruction. BJU Int. 2004;93:346.PubMedCrossRefGoogle Scholar
  22. 22.
    Shore ND, Dineen MK, Saslawsky MJ, et al. A temporary intraurethral prostatic stent relieves prostatic obstruction following transurethral microwave thermotherapy. J Urol. 2007;177:1040.PubMedCrossRefGoogle Scholar
  23. 23.
    Kojima M, Watanabe H, Watanabe M, et al. Preliminary results of power Doppler imaging in benign prostatic hyperplasia. Ultrasound Med Biol. 1997;23:1305.PubMedCrossRefGoogle Scholar
  24. 24.
    Berger AP, Horninger W, Bektic J, et al. Vascular resistance in the prostate evaluated by colour Doppler ultrasonography: is benign prostatic hyperplasia a vascular disease? BJU Int. 2006;98:587.PubMedCrossRefGoogle Scholar
  25. 25.
    Shinbo H, Kurita Y, Takada S, et al. Resistive index as risk factor for acute urinary retention in patients with benign prostatic hyperplasia. Urology. 2010;76:1440.PubMedCrossRefGoogle Scholar
  26. 26.
    • Zhang X, Li G, Wei X, et al. Resistive index of prostate capsular arteries: a newly identified parameter to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia. J Urol. 2012;188:881. The authors report the association of the resistive index of the prostate capsular arteries and BOO/LUTS severity. Clinical implications are promising.PubMedCrossRefGoogle Scholar
  27. 27.
    Chen IH, Tsai YS, Tong YC. Correlations among cardiovascular risk factors, prostate blood flow, and prostate volume in patients with clinical benign prostatic hyperplasia. Urology. 2012;79:409.PubMedCrossRefGoogle Scholar
  28. 28.
    Han DH, Lee HW, Sung HH, et al. The diagnostic efficacy of 3-dimensional ultrasound estimated bladder weight corrected for body surface area as an alternative nonurodynamic parameter of bladder outlet obstruction. J Urol. 2011;185:964.PubMedCrossRefGoogle Scholar
  29. 29.
    Yuen JS, Ngiap JT, Cheng CW, et al. Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. Int J Urol. 2002;9:225.PubMedCrossRefGoogle Scholar
  30. 30.
    Chia SJ, Heng CT, Chan SP, et al. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int. 2003;91:371.PubMedCrossRefGoogle Scholar
  31. 31.
    Foo KT. Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound. Int J Urol. 2010;17:974.PubMedCrossRefGoogle Scholar
  32. 32.
    • Farag FF, Martens FM, D’Hauwers KW, et al. Near-infrared spectroscopy: a novel, noninvasive, diagnostic method for detrusor overactivity in patients with overactive bladder symptoms—a preliminary and experimental study. Eur Urol. 2011;59:757. They introduce Near-infrared spectroscopy (NIRS) as novel, noninvasive and potentially clinically applicable method for evaluation of bladder overacitivity. Validation and standardization of the mathematical algorythm is pending.PubMedCrossRefGoogle Scholar
  33. 33.
    Chung DE, Lee RK, Kaplan SA, et al. Concordance of near infrared spectroscopy with pressure flow studies in men with lower urinary tract symptoms. J Urol. 2010;184:2434.PubMedCrossRefGoogle Scholar
  34. 34.
    Slawin KM, Shariat S, Canto E. BPSA: a novel serum marker for benign prostatic hyperplasia. Rev Urol. 2005;7 Suppl 8:S52.PubMedGoogle Scholar
  35. 35.
    Canto EI, Singh H, Shariat SF, et al. Serum BPSA outperforms both total PSA and free PSA as a predictor of prostatic enlargement in men without prostate cancer. Urology. 2004;63:905.PubMedCrossRefGoogle Scholar
  36. 36.
    Linton HJ, Marks LS, Millar LS, et al. Benign prostate-specific antigen (BPSA) in serum is increased in benign prostate disease. Clin Chem. 2003;49:253.PubMedCrossRefGoogle Scholar
  37. 37.
    Cannon GW, Mullins C, Lucia MS, et al. A preliminary study of JM-27: a serum marker that can specifically identify men with symptomatic benign prostatic hyperplasia. J Urol. 2007;177:610.PubMedCrossRefGoogle Scholar
  38. 38.
    Cannon GW, Getzenberg RH. JM-27: a biomarker for symptomatic benign prostatic hyperplasia and lower urinary tract symptoms. Current Prostate Reports. 2008;6:19.CrossRefGoogle Scholar
  39. 39.
    Merendino RA, Salvo F, Saija A, et al. Malondialdehyde in benign prostate hypertrophy: a useful marker? Mediators Inflamm. 2003;12:127.PubMedCrossRefGoogle Scholar
  40. 40.
    Liao CH, Chung SD, Kuo HC. Serum C-reactive protein levels are associated with residual urgency symptoms in patients with benign prostatic hyperplasia after medical treatment. Urology. 2011;78:1373.PubMedCrossRefGoogle Scholar
  41. 41.
    Schenk JM, Kristal AR, Neuhouser ML, et al. Biomarkers of systemic inflammation and risk of incident, symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol. 2010;171:571.PubMedCrossRefGoogle Scholar
  42. 42.
    Rohrmann S, De Marzo AM, Smit E, et al. Serum C-reactive protein concentration and lower urinary tract symptoms in older men in the Third National Health and Nutrition Examination Survey (NHANES III). Prostate. 2005;62:27.Google Scholar
  43. 43.
    Neuhouser ML, Schenk J, Song YJ, et al. Insulin-like growth factor-I, insulin-like growth factor binding protein-3 and risk of benign prostate hyperplasia in the prostate cancer prevention trial. Prostate. 2008;68:1477.PubMedCrossRefGoogle Scholar
  44. 44.
    • Sauver JLS, Jacobson DJ, McGree ME, et al. Associations between longitudinal changes in serum estrogen, testosterone, and bioavailable testosterone and changes in benign urologic outcomes. Am J Epidemiol. 2011;173:787. The paper suggests that both absolute sex steroid hormone levels and the rates at which the levels change may be important in the development of urologic conditions in aging men.CrossRefGoogle Scholar
  45. 45.
    Tan MO, Karabiyik I, Uygur MC, et al. Serum concentrations of sex hormones in men with severe lower urinary tract symptoms and benign prostatic hyperplasia. Int Urol Nephrol. 2003;35:357.PubMedCrossRefGoogle Scholar
  46. 46.
    Liu B, Zheng BZ, Zhou ZL, et al. Change of nerve growth factor mRNA in human detrusor in bladder outlet obstruction with benign prostatic hyperplasia and their implication. Zhonghua Wai Ke Za Zhi. 2004;42:874.PubMedGoogle Scholar
  47. 47.
    Liu HT, Kuo HC. Urinary nerve growth factor levels are increased in patients with bladder outlet obstruction with overactive bladder symptoms and reduced after successful medical treatment. Urology. 2008;72:104.PubMedCrossRefGoogle Scholar
  48. 48.
    • Watanabe T, Inoue M, Ishii A. Urinary nerve growth factor level in patients with benign prostatic obstruction (bpo) is correlated with severity of symptoms and response to medical treatment. J Urol. 2011;185(4s):e695–6. Demonstrates the level of BPO bio markers and its response to treatment.CrossRefGoogle Scholar
  49. 49.
    Kim JC, Park EY, Hong SH, et al. Changes of urinary nerve growth factor and prostaglandins in male patients with overactive bladder symptom. Int J Urol. 2005;12:875.PubMedCrossRefGoogle Scholar
  50. 50.
    Kurizaki Y, Ishizuka O, Imamura T, et al. Relation between expression of alpha(1)-adrenoceptor mRNAs in bladder mucosa and urodynamic findings in men with lower urinary tract symptoms. Scand J Urol Nephrol. 2011;45:15.PubMedCrossRefGoogle Scholar
  51. 51.
    Kalorin CM, Mannikarottu A, Neumann P, et al. Protein oxidation as a novel biomarker of bladder decompensation. BJU Int. 2008;102:495.PubMedCrossRefGoogle Scholar
  52. 52.
    Shi B, Zhu Y, Laudon V, et al. Alterations of urine TGF-beta1 and bFGF following bladder outlet obstruction: a predictor for detrusor contractibility? Urol Int. 2009;82:43.PubMedCrossRefGoogle Scholar
  53. 53.
    Guven A, Kalorin C, Onal B, et al. Novel biomarkers of bladder decompensation after partial bladder obstruction. Neurourol Urodyn. 2007;26:1036.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Shahin Tabatabaei
    • 1
  • Saman Shafaat Talab
    • 1
  • Mahdi Zangi
    • 2
  • Henry H. Woo
    • 3
  1. 1.Department of UrologyHarvard Medical School, Massachusetts General HospitalBostonUSA
  2. 2.Shahid Beheshti University of Medical SciencesShahrak-GharbIran
  3. 3.Sydney Adventist Hospital Clinical School, University of SydneyWahroongaAustralia

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