Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are afected—but lower urinary tract symptoms also affect women. The condition is also termed prostatism in men, but LUTS is preferred. Symptoms and signs Symptoms can be categorised into: Filling (storage) or irritative symptoms Increased frequency of urination Increased urgency of urination Urge incontinence Excessive passage of urine at night Voiding or obstructive symptoms Poor stream (unimproved by straining) Hesitancy Terminal dribbling Incomplete voiding Urinary retention Overflow incontinence (occurs in chronic retention) Episodes of near retention As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer. Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis. Also, recently a report of lower urinary tract symptoms even with malignant features in the prostate failed to be associated with prostate cancer after further laboratory investigation of the biopsy. Causes Benign prostatic hyperplasia (BPH) Bladder stone Cancer of the bladder and prostate Detrusor muscle weakness and/or instability Diabetes Use of ketamine Neurological conditions; for example multiple sclerosis, spinal cord injury, cauda equina syndrome Prostatitis, including IgG4-related prostatitis Urethral stricture Urinary tract infections (UTIs) Diagnosis The International Prostate Symptom Score (IPSS) can be used to gauge the symptoms, along with physician examination. Other primary and secondary tests are often carried out, such as a PSA (Prostate-specific antigen) test, urinalysis, ultrasound, urinary flow studies, imaging, temporary prostatic stent placement, prostate biopsy and/or cystoscopy. Placement of a temporary prostatic stent as a differential diagnosis test can help identify whether LUTS symptoms are directly related to obstruction of the prostate or to other factors worth investigation. Treatment Treatment will depend on the cause, if one is found. For example; with a UTI, a course of antibiotics would be given; appropriate medication would be administered to treat benign prostatic hyperplasia. Lifestyle changes Other treatments include lifestyle advice; for example, avoiding dehydration in recurrent cystitis. Men with prostatic hypertrophy are advised to sit down whilst urinating. A 2014 meta-analysis found that, for elderly males with LUTS, sitting to urinate meant there was a decrease in post-void residual volume (PVR, ml), increased maximum urinary flow (Qmax, ml/s), which is comparable with pharmacological intervention, and decreased the voiding time