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The Lower Urinary Tract Symptoms

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Lower Urinary Tract Symptoms in Adults

Abstract

Lower urinary tract symptoms (LUTS) are categorized according to how they relate to the storage and voiding cycle. This relationship indicates whether there is a problem when the bladder is storing urine, or whilst the bladder is emptying or straight afterwards. Even though the LUTS are grouped in this way, potential underlying mechanisms are very diverse, and the balance of symptoms can indicate causative factors. Crucially, two symptoms (nocturia and increased daytime frequency) are LUTS, but they can also arise from mechanisms entirely unrelated to the lower urinary tract, namely medical or behavioural issues altering urine output from the kidneys.

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References

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    PubMed  Google Scholar 

  2. Batista-Miranda JE, Molinuevo B, Pardo Y. Impact of lower urinary tract symptoms on quality of life using Functional Assessment Cancer Therapy scale. Urology. 2007;69(2):285–8.

    Article  PubMed  Google Scholar 

  3. D’Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433–77.

    Article  PubMed  Google Scholar 

  4. Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014;65(2):389–98.

    Article  PubMed  Google Scholar 

  5. Li R, Zhu Q, Nibouche M, Gammie A. Urine flow rate curve shapes and their descriptors. Neurourol Urodyn. 2018;37(8):2938–44.

    Article  PubMed  Google Scholar 

  6. Reynard JM, Peters TJ, Lamond E, Abrams P. The significance of abdominal straining in men with lower urinary tract symptoms. Br J Urol. 1995;75:148–53.

    Article  CAS  PubMed  Google Scholar 

  7. Maserejian NN, Kupelian V, McVary KT, Doshi M, Link CL, McKinlay JB. Prevalence of post-micturition symptoms in association with lower urinary tract symptoms and health-related quality of life in men and women. BJU Int. 2011;108(9):1452–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wille S, Mills RD, Studer UE. Absence of urethral post-void milking: an additional cause for incontinence after radical prostatectomy? Eur Urol. 2000;37(6):665–9.

    Article  CAS  PubMed  Google Scholar 

  9. Furuya S, Yokoyama E. Urodynamic studies on postmicturition dribble. Hinyokika Kiyo. 1983;29(4):395–400.

    CAS  PubMed  Google Scholar 

  10. Agarwal A, Eryuzlu LN, Cartwright R, Thorlund K, Tammela TL, Guyatt GH, et al. What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women. Eur Urol. 2014;65(6):1211–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Poyhonen A, Auvinen A, Koskimaki J, Hakama M, Tammela TL, Hakkinen JT. Prevalence and bother of postmicturition dribble in Finnish men aged 30-80 years: Tampere Ageing Male Urologic Study (TAMUS). Scand J Urol Nephrol. 2012;46(6):418–23.

    Article  PubMed  Google Scholar 

  12. Stephenson TP, Farrar DJ. Urodynamic study of 15 patients with postmicturition dribble. Urology. 1977;9(4):404–6.

    Article  CAS  PubMed  Google Scholar 

  13. Yang DY, Ko K, Lee SH, Cho JS, Lee SK, Shin TY, et al. Postmicturition dribble is associated with erectile dysfunction in middle-aged and older men with lower urinary tract symptoms. World J Mens Health. 2018;36(3):263–70.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sountoulides P, Mutomba WF. Feeling of incomplete bladder emptying: a definition with clinical implications. Low Urin Tract Symptoms. 2019;11(1):85.

    Article  PubMed  Google Scholar 

  15. Ozlulerden Y, Toktas C, Zumrutbas AE, Gulten MC, Baser A, Yapici O, et al. Can feeling of incomplete bladder emptying reflect significant postvoid residual urine? Is it reliable as a symptom solely? Investig Clin Urol. 2018;59(1):38–43.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee JY, Lee DH, Lee H, Bang WJ, Hah YS, Cho KS. Clinical implications of a feeling of incomplete emptying with little post-void residue in men with lower urinary tract symptoms. Neurourol Urodyn. 2014;33(7):1123–7.

    Article  PubMed  Google Scholar 

  17. Kobayashi M, Tokura Y, Kambara T, Nukui A, Kamai T. Feeling of incomplete emptying with little post-void residual in patients with lower urinary tract symptoms: clinical implications and treatment outcomes. Low Urin Tract Symptoms. 2019;11(2):O59–64.

    Article  PubMed  Google Scholar 

  18. Chapple CR, Osman NI, Birder L, Dmochowski R, Drake MJ, van Koeveringe G, et al. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn. 2018;37(8):2928–31.

    Article  PubMed  Google Scholar 

  19. Smith PP, Birder LA, Abrams P, Wein AJ, Chapple CR. Detrusor underactivity and the underactive bladder: symptoms, function, cause-what do we mean? ICI-RS think tank 2014. Neurourol Urodyn. 2016;35(2):312–7.

    Article  PubMed  Google Scholar 

  20. Andersson KE. Detrusor underactivity/underactive bladder: new research initiatives needed. J Urol. 2010;184(5):1829–30.

    Article  PubMed  Google Scholar 

  21. Chancellor MB, Kaufman J. Case for pharmacotherapy development for underactive bladder. Urology. 2008;72:966–7.

    Article  PubMed  Google Scholar 

  22. Wyndaele JJ, De Wachter S. Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval. Eur Urol. 2002;42(1):34–8.

    Article  CAS  PubMed  Google Scholar 

  23. Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: a report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017;36(4):984–1008.

    Article  PubMed  Google Scholar 

  24. Drake MJ, Abrams P. A commentary on expectations of healthcare professionals when applying the international continence society standards to basic assessment of lower urinary tract function. Neurourol Urodyn. 2018;37(S6):S7–S12.

    Article  PubMed  Google Scholar 

  25. Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V, et al. International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function. Neurourol Urodyn. 2019;38(2):499–508.

    Article  PubMed  Google Scholar 

  26. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–14. discussion 14-5.

    Article  PubMed  Google Scholar 

  27. Van Kerrebroeck P, Andersson KE. Terminology, epidemiology, etiology, and pathophysiology of nocturia. Neurourol Urodyn. 2014;33(Suppl 1):S2–5.

    Article  PubMed  Google Scholar 

  28. Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S, et al. A practical approach to the management of nocturia. Int J Clin Pract. 2017;71(11):e13027.

    Article  PubMed Central  Google Scholar 

  29. Andersson F, Anderson P, Holm-Larsen T, Piercy J, Everaert K, Holbrook T. Assessing the impact of nocturia on health-related quality-of-life and utility: results of an observational survey in adults. J Med Econ. 2016;19(12):1200–6.

    Article  PubMed  Google Scholar 

  30. Gulur DM, Mevcha AM, Drake MJ. Nocturia as a manifestation of systemic disease. BJU Int. 2011;107(5):702–13.

    Article  PubMed  Google Scholar 

  31. Everaert K, Anderson P, Wood R, Andersson FL, Holm-Larsen T. Nocturia is more bothersome than daytime LUTS: results from an observational, real-life practice database including 8659 European and American LUTS patients. Int J Clin Pract. 2018;72(6):e13091.

    Article  PubMed  Google Scholar 

  32. Goessaert AS, Krott L, Walle JV, Everaert K. Exploring nocturia: gender, age, and causes. Neurourol Urodyn. 2015;34(6):561–5.

    Article  CAS  PubMed  Google Scholar 

  33. Breyer BN, Shindel AW, Erickson BA, Blaschko SD, Steers WD, Rosen RC. The association of depression, anxiety and nocturia: a systematic review. J Urol. 2013;190(3):953–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Temml C, Ponholzer A, Gutjahr G, Berger I, Marszalek M, Madersbacher S. Nocturia is an age-independent risk factor for hip-fractures in men. Neurourol Urodyn. 2009;28(8):949–52.

    Article  PubMed  Google Scholar 

  35. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol. 2011;185(2):571–7.

    Article  PubMed  Google Scholar 

  36. Nakagawa H, Niu K, Hozawa A, Ikeda Y, Kaiho Y, Ohmori-Matsuda K, et al. Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol. 2010;184(4):1413–8.

    Article  PubMed  Google Scholar 

  37. Fan Y, Wei F, Lang Y, Qi W. Meta-analysis of nocturia and risk of all-cause mortality in adult population. Int J Cardiol. 2015;195:120–2.

    Article  PubMed  Google Scholar 

  38. Ancoli-Israel S, Bliwise DL, Norgaard JP. The effect of nocturia on sleep. Sleep Med Rev. 2011;15(2):91–7.

    Article  PubMed  Google Scholar 

  39. Bliwise DL, Holm-Larsen T, Goble S, Norgaard JP. Short time to first void is associated with lower whole-night sleep quality in nocturia patients. J Clin Sleep Med. 2015;11(1):53–5.

    PubMed  PubMed Central  Google Scholar 

  40. Juul KV, Jessen N, Bliwise DL, van der Meulen E, Norgaard JP. Delaying time to first nocturnal void may have beneficial effects on reducing blood glucose levels. Endocrine. 2016;53(3):722–9.

    Article  CAS  PubMed  Google Scholar 

  41. Negoro H, Kanematsu A, Yoshimura K, Ogawa O. Chronobiology of micturition: putative role of the circadian clock. J Urol. 2013;190(3):843–9.

    Article  PubMed  Google Scholar 

  42. Goessaert AS, Schoenaers B, Opdenakker O, Hoebeke P, Everaert K, Vande Walle J. Long-term followup of children with nocturnal enuresis: increased frequency of nocturia in adulthood. J Urol. 2014;191(6):1866–70.

    Article  PubMed  Google Scholar 

  43. Everaert K, Herve F, Bower W, Djurhuus JC, Dmochowski R, Fine N, et al. How can we develop a more clinically useful and robust algorithm for diagnosing and treating nocturia? ICI-RS 2017. Neurourol Urodyn. 2018;37(S4):S46–59.

    Article  PubMed  Google Scholar 

  44. Denys MA, Decalf V, Kumps C, Petrovic M, Goessaert AS, Everaert K. Pathophysiology of nocturnal lower urinary tract symptoms in older patients with urinary incontinence. Int J Urol. 2017;24(11):808–15.

    Article  PubMed  Google Scholar 

  45. Cornu JN, Abrams P, Chapple CR, Dmochowski RR, Lemack GE, Michel MC, et al. A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management--a systematic review and meta-analysis. Eur Urol. 2012;62(5):877–90.

    Article  PubMed  Google Scholar 

  46. Weiss JP. Nocturia: focus on etiology and consequences. Rev Urol. 2012;14(3–4):48–55.

    PubMed  PubMed Central  Google Scholar 

  47. Rittig S, Knudsen UB, Norgaard JP, Pedersen EB, Djurhuus JC. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Phys. 1989;256(4 Pt 2):F664–71.

    CAS  Google Scholar 

  48. Oelke M, Anderson P, Wood R, Holm-Larsen T. Nocturia is often inadequately assessed, diagnosed and treated by physicians: results of an observational, real-life practice database containing 8659 European and US-American patients. Int J Clin Pract. 2016;70(11):940–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Sakalis VI, Karavitakis M, Bedretdinova D, Bach T, Bosch J, Gacci M, et al. Medical treatment of nocturia in men with lower urinary tract symptoms: systematic review by the European Association of Urology Guidelines Panel for male lower urinary tract symptoms. Eur Urol. 2017;72(5):757–69.

    Article  PubMed  Google Scholar 

  50. Everaert K, Herve F, Bosch R, Dmochowski R, Drake M, Hashim H, et al. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn. 2019;38(2):478–98.

    Article  PubMed  Google Scholar 

  51. Kalejaiye O, Vij M, Drake MJ. Classification of stress urinary incontinence. World J Urol. 2015;33(9):1215–20.

    Article  PubMed  Google Scholar 

  52. Osman NI, Marzi VL, Cornu JN, Drake MJ. Evaluation and classification of stress urinary incontinence: current concepts and future directions. Eur Urol Focus. 2016;2(3):238–44.

    Article  PubMed  Google Scholar 

  53. Gajewski JB, Drake MJ. Neurological lower urinary tract dysfunction essential terminology. Neurourol Urodyn. 2018;37(S6):S25–31.

    Article  PubMed  Google Scholar 

  54. Hashim H, Drake MJ. Basic concepts in nocturia, based on International Continence Society standards in nocturnal lower urinary tract function. Neurourol Urodyn. 2018;37(S6):S20–4.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Cardiff and Vale University Health Board, Cardiff, UK

    Haitham Abdelmoteleb

  2. University of Florence, Florence, Italy

    Martino Aiello

  3. University of Bristol, Bristol, UK

    Marcus Drake

  4. University of Ghent, Gent, Belgium

    Karel Everaert, An-Sofie Goessaert & Tove Holm-Larsen

  5. Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

    Rita Rodrigues Fonseca & Renato Lains Mota

  6. Nova Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal

    Rita Rodrigues Fonseca

  7. Moscow State University of Medicine and Dentistry, Moscow, Russia

    George Kasyan

  8. Pharma Evidence, Farum, Denmark

    Tove Holm-Larsen

  9. Hospital Ramón y Cajal, Madrid, Spain

    Luis López-Fando

  10. SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Thomas Monaghan

  11. Universitair Ziekenhuis, Ghent, Belgium

    Toon Mylle

  12. Ghent University Hospital, Ghent, Belgium

    Kim Pauwaert

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  1. Haitham Abdelmoteleb
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  2. Martino Aiello
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  3. Marcus Drake
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Correspondence to Marcus Drake .

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Editors and Affiliations

  1. Department of Urology, University of Bristol, Bristol, UK

    Marcus Drake

  2. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Andrea Cocci

  3. Faculdade de Medicina de Lisboa, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Ricardo Pereira e Silva

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Abdelmoteleb, H. et al. (2020). The Lower Urinary Tract Symptoms. In: Drake, M., Cocci, A., Pereira e Silva, R. (eds) Lower Urinary Tract Symptoms in Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-27747-5_2

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  • DOI: https://doi.org/10.1007/978-3-030-27747-5_2

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