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Head To Head

Should we treat lower urinary tract symptoms without a definitive diagnosis? Yes

BMJ 2011; 343 doi: (Published 01 December 2011) Cite this as: BMJ 2011;343:d6038
  1. Paul Abrams, professor of urology
  1. 1Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK
  1. paul_abrams{at}

Paul Abrams argues that invasive investigations are unnecessary and impractical for most patients with lower urinary tract symptoms, but Julian Shah (doi:10.1136/bmj.d6058) thinks they are essential for successful treatment

Lower urinary tract symptoms (LUTS) are common in the general population, their main causes (including overactive bladder and benign prostatic obstruction) are not life threatening, definitive diagnosis is invasive, and initial management is safe. Initial treatment of the symptoms without a definitive diagnosis is therefore sensible and avoids unnecessary secondary care.

Defining the problem

Around 1.8 billion men and women worldwide have LUTS, and the numbers are increasing rapidly as the population ages.1 The term was introduced in 1994 to escape the “prostate-centric” approach of doctors to lower urinary tract symptoms in men, which led to many men having unnecessary prostate surgery when their symptoms had other causes.2 Later, the International Continence Society divided symptoms into three categories: storage LUTS, including the symptoms of overactive bladder (urgency, urgency urinary incontinence, frequency, and nocturia) and stress urinary incontinence; voiding LUTS, including slow stream and hesitancy; and post-micturition LUTS, such as a feeling of …

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