Higher Health Authority recommendation for the initial assessment of urinary disorders in adult men.
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Higher Health Authority recommendation for the initial assessment of urinary disorders in adult men.

We are talking about men aged 50 years and older with urinary disorders (filling, voiding or post-micturition phases) or a complication associated with impaired emptying of the lower urinary tract (urinary retention, acute or chronic, infectious complications, stones, diverticulum, etc.). Patients with LUTS associated with another already established diagnosis (neurological pathology, urethral stenosis, bladder tumor) are excluded. Here are the main points.

Initial assessment

  • Repeat the assessment if the original assessment was completed more than a year ago.
  • Collect risk factors for cardiovascular disease, screen for metabolic syndrome, and inventory treatments.
  • Check for contraindications to drug treatment or drug interactions, especially in elderly patients.
  • Collect data on urinary and sexual symptoms (using a structured interview or a validated questionnaire).
  • Examine the lumbar fossa, pelvis, prostate and external genitalia.
  • Ask the patient to follow a urination schedule in the event of predominant disturbances in the filling phase of the bladder.
  • Perform urine dipstick or ECBU to detect microscopic hematuria, leukocyturia, and glycosuria.
  • Do an abdominal (not endorectal) ultrasound of the urinary system. The identified morphological elements (prostatic protrusion index, detrusor thickness or estimated bladder weight) are not relevant when deciding whether to initiate treatment.
  • Measure post-urinary residue (ultrasonic or automatic measuring device).
  • Do not perform CT, MRI, urodynamic studies, endorectal ultrasound, or cystoscopy.

The initial assessment will lead to patient monitoring or treatment. The proposal for surgery is the responsibility of the urologist.

Urological report necessary if the following data is collected:

  • Upon questioning and clinical examination: hematuria, recurrent urinary tract infections, persistent pelvic pain, urinary retention, abnormalities of the external genitalia, suspicious prostate induration.
  • The presence of urinary symptoms that predominate in the filling phase (specified using the urination calendar).
  • On ultrasound: significant residue after urination, bladder lithiasis, bladder diverticulum, hydronephrosis, and other morphological abnormalities of the urinary system.
  • In ECBU: persistent leukocyturia and/or hematuria.
  • Suspicious increase in PSA (prostate specific antigen) level.
  • Failure of drug treatment or persistence of significant urine residues after initiation of drug treatment.

It is the urologist who decides whether to perform flowmetry with measurement of voided residues, urethrocystoscopy and urodynamic assessment. The mention of these three examinations is the main difference between the part of the recommendations intended for general practitioners and that addressed to specialists.

Article written by Serge Cannasse and published on December 21, 2023 on Univadis.

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