ABSTRACT
History and Physical Examination When obtaining a history, consider the patient’s age. Because prostate size increases with age, LUTS are most likely due to BPH in men older than 50 years, and LUTS are most likely due to other conditions in men younger than 40 years. Reviewing medications is also essential because many medications cause LUTS by affecting detrusor muscle and urinary sphincter function: 1) anticholinergic and antimuscarinic medications decrease detrusor muscle tone; 2) sympathomimetic medications increase urethral sphincter tone; and 3) diuretics increase urinary frequency (Table 16-1). Additionally, overthe-counter cold medications may cause LUTS by various mechanisms. When older men with subclinical BPH simply discontinue taking new medications, LUTS often resolve. Finally, a focused review of systems should identify fever, hematuria (indicating urothelial malignancy), urethral instrumentation or sexually transmitted diseases (suggesting the possibility of urethral stricture), sleep disturbances, patterns of fluid intake, and use of alcohol and caffeine.
