LUTS, or lower urinary tract symptoms, relate to functional or structural problems in the prostate, bladder or urethra. The frequency with which men experience these symptoms typically increases with age, and they can be very distressing, significantly impacting quality of life.
Mr Rahim Kaba offers a comprehensive range of diagnostic tests to assess and diagnose your condition accurately. He can then advise you on the most appropriate and effective medical treatment or surgical procedure.
LUTS treatments & investigations
FAQs
What are LUTS treatments & investigations?
LUTS treatments & investigations refer to the diagnosis and treatment of lower urinary tract symptoms (LUTS), which are related to problems concerning the lower urinary tract. The lower urinary tract consists of the bladder, the prostate and the urethra.
We can class LUTS as a broad group of symptoms which are related to the storing or passing of urine. Symptoms can be linked to one or both issues. Common causes of LUTS include a urinary tract infection, a benign prostate gland enlargement, an inflammation of the prostate, or an overactive bladder.
The prostate is a small gland in the pelvis only found in men. It’s located between the penis and bladder and surrounds the urethra (the tube that carries urine from the bladder to the penis).
If the prostate becomes enlarged, it can place pressure on the bladder and urethra. This can cause symptoms that affect urination.
There are several treatments for LUTS – from lifestyle changes to addressing related health conditions and medications. Finally, there are several surgical procedures – which we will detail on this page.
It is understood that men with LUTS have significantly more chance of having erectile dysfunction than those without urinary symptoms. For this reason, LUTS treatments could also be effective in treating erectile dysfunction.
Am I a good candidate for LUTS treatments & investigations?
You might require LUTS treatments and investigations if you experience typical LUTS symptoms such as; a weak stream when urinating; an abnormally long wait (hesitancy) when urinating; dribbling after urination; straining while urinating; an intermittent stream; feeling a sudden and urgent need to urinate; waking up to urinate twice or more each night; urinating without control; or an abnormally short time between feeling the urge to urinate.
How do LUTS treatments & investigations work?
If you notice changes to your urination, such as the symptoms outlined above, you should see your doctor. Investigations to establish whether you have LUTS can include; questions from your doctor, a review of your medical history, and examinations such as post-void bladder scanning, flow rate, urinalysis and routine blood tests.
The first treatments suggested for LUTS can be lifestyle changes such as reducing alcohol or caffeine intake, as these substances may both irritate the bladder. These lifestyle changes may require you to exercise more or alter your diet, in order to address conditions such as obesity, hypertension or diabetes.
Medicines to treat LUTS include anticholinergic, combination treatments, alpha-blockers (tamsulosin), phosphodiesterase-5 inhibitors, and 5 alpha reductase inhibitors (finasteride)
For severe LUTS and very bothersome symptoms surgery may be recommended.
Once all of your investigations have been performed and the results are through then Mr Kaba will explain everything to you. He will discuss all the options with you and put forward an appropriate tailored management plan.
Surgery Options for Prostate Enlargement
Rez̄um
Trans-urethral needle water vapourisation of the prostate for symptomatic benign prostatic enlargement
This is a new minimally-invasive or endoscopic surgical procedure that involves using water vapour (steam) to remove obstructing prostate tissue. This improves the flow of urine from the bladder to the outside. Its unique benefits are the significantly lower risk of bleeding and sexual function side effects.
Why is the Rez̄um procedure carried out?
The Rez̄um procedure recommended when prostate enlargement (benign prostatic hyperplasia) causes troublesome symptoms and fails to respond to treatment with medication. It is also an option in men who wish to avoid taking long-term medication and therefore also avoiding side effects of such medication.
What symptoms may improve after the Rez̄um procedure?
- problems starting to urinate (hesitancy)
- a weak urine flow or stopping and starting
- having to strain to pass urine
- a frequent need to urinate
- waking up frequently during the night to urinate (nocturia)
- a sudden urge to urinate (urgency)
- being unable to empty your bladder fully
When is the Rez̄um procedure recommended for prostate enlargement (benign prostatic hyperplasia)?
Key benefits of the key benefits of the Rez̄um procedure:
- Fast, effective and, precise BPH treatment
- Ablates targeted tissue, which is then reabsorbed
- Treats enlarged central zones and/or median lobes
- Clinically proven, safe and effective
- Reduced risk of bleeding (compared to standard Trans-urethral resection of the prostate (TURP)
- Preserves sexual functions
- Rapid return to normal activities
Are there any alternatives to the Rez̄um procedure?
- Monopolar or Regular/Standard TURP
- Bipolar TURP
- Laser Prostatectomy
- Urolift
What to expect after surgery?
- During your hospitalisation
Following your surgery, you will be transferred to the recovery room and then to your hospital room once you are fully awake. - Post-operative pain
Following surgery, pain is typically minimal and controllable with oral analgesics which will be prescribed. - Urinary catheter
A bladder catheter is placed in the operating theatre while you are asleep and left in place for typically 7-10 days after the surgery. - Diet
Your diet will be advanced slowly from clear liquids to solid foods as tolerated once fully awake. In addition, intravenous fluids will be administered to keep your body well hydrated following surgery. - Fatigue
Fatigue is not uncommon and should start to subside in a few weeks following surgery. - Physical activity
On the evening of or latest morning after surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. During and after your hospital stay it is advised that you keep walking – The more walking you can tolerate the better. - Hospital stay
The Rez̄um procedure is a day-case procedure – patients are discharged home with a catheter the same day.
UroLift
The UroLift® system received Interventional Procedures Guidance from NICE in January 2014.
The UroLift® is a minimally invasive treatment option for patients with urinary symptoms secondary to BPH. This treatment directly opens a channel in the anterior of the prostatic urethra by retracting the obstructing prostatic lobes without cutting, heating or removing prostate tissue. The prostatic lobes are retracted by using small permanent implants. Clinical data has shown the following:
- Rapid symptom relief as early as 2 weeks post-procedure with only mild urinary discomfort post-procedure during the recovery period
- Successful prostatic urethral opening is endoscopically confirmed immediately post-procedure
- Majority of patients do not require post treatment catheterisation
- There have been no reports of new onset of sexual dysfunction, retrograde ejaculation or permanent erectile dysfunction following treatment with the UroLift® System
Patients most suitable for this new treatment:
- Patients with prostates 80cc and smaller, not in retention, with little to no median lobe and no prostate cancer
- Patients that have tried drug therapies but can’t tolerate the side effects or are no longer obtaining any benefit from drug therapy
- Patients with significant urinary symptoms that possibly need surgical intervention but don’t want to lose sexual function
- Patients that want a minimally invasive procedure with a faster recovery time than conventional procedures
TURP
TURP is an operation to remove some of the enlarged prostate gland to relieve pressure on the urethra and allow the urine to drain more easily.
For some patients a TURP might be a better way of removing a larger amount of tissue and give a better resolution of symptoms in men with bigger prostates and those with significant urinary retention.
The operation is performed under a spinal or a general anaesthetic and a telescope is passed into the bladder via the urethra. The obstructing part of the prostate is then removed by cutting away pieces of the prostate using a heated wire loop.
Patients have a catheter in place for 1-2 days and are usually discharged on the day of removal. It may take up to 3 months before all the irritation associated with the operation settles although the majority of patients will feel the benefit as soon as the catheter is removed.
There is a chance of erectile problems in the order of 5-10% following the TURP.
Mr Rahim Kaba
Mr Rahim Kaba is a highly skilled Consultant Urological Surgeon practicing at Nuffield Heath Warwickshire Hospital in Leamington Spa. He also serves as an Honorary Clinical Lecturer at Warwick Medical School within the South Warwickshire NHS Foundation Trust (SWFT).
Mr Kaba treats urinary infections, male urinary/prostatic symptoms, PSA/prostate cancer investigations, haematuria, female incontinence, impotence, penile, and testicular issues.
He specialises in lower urinary tract dysfunction, offering advanced minimally invasive treatments such as REZUM, Urolift, conventional bipolar TURP, and Aquablation for men with lower urinary tract dysfunction in the West Midlands. He played a pivotal role in launching the Aquablation in the West Midlands and conducted the inaugural case.
