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Should we treat lower urinary tract symptoms without a definitive diagnosis? No

BMJ 2011; 343 doi: (Published 01 December 2011) Cite this as: BMJ 2011;343:d6058
  1. Julian R Shah, consultant urological surgeon
  1. 1 Institute of Urology and University College London Hospitals, London, UK
  1. pjrshah{at}

Paul Abrams (doi:10.1136/bmj.d6038) argues that invasive investigations are unnecessary and impractical for most patients with lower urinary tract symptoms, but Julian Shah thinks they are essential for successful treatment

The term “lower urinary tract symptoms” (LUTS) was coined to cover the variety of symptoms that affect the bladder. The symptoms may be storage or emptying symptoms or both. It was initially introduced because of the potential difficulty with terms such as “prostatism,” which described bladder symptoms in older men that were thought to be due to prostatic enlargement. Unfortunately, the term has been extended to apply to any patient, male or female, young or old, with urinary symptoms. The other arguably misleading term that has come into common parlance is “overactive bladder.” Both these terms are non-specific, non-diagnostic descriptions of symptom complexes. Yet their widespread use can easily lead to treatment being decided without any knowledge of the underlying condition.

From a clinical point of view, the term prostatism is more useful. Although it is also non-specific, it applied to a specific patient group—older men with prostatic enlargement with symptoms usually caused, …

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