The diagnostic value of abdominal ultrasound, urine cytology and prostate-specific antigen testing in the lower urinary tract symptoms clinic.
BACKGROUND
Lower urinary tract symptoms (LUTS) affect 18-26% of men aged 40-79 years, many of whom present with a fear of having cancer. Current guidelines for the assessment of LUTS focus mainly upon benign prostatic hypertrophy. It has been our practice to perform an abdominal ultrasound scan (USS), a prostate-specific antigen (PSA) blood test and urine cytology during the assessment of males presenting with LUTS to investigate the alternative potentially life-threatening causes for LUTS. We report on the added value of these tests during the assessment of men with LUTS.


RESULTS
A total of 263/3976 (6.6%) patients investigated for LUTS were found to have incidental urological malignancies, urinary tract calculi or abdominal aortic aneurysms (AAA). Abdominal USSs resulted in the incidental diagnosis of four renal carcinomas (0.1%), 45 AAAs (incidence = 1.1%) and 44 urinary tract calculi (1.1%). Urine cytology testing and bladder USSs helped diagnose 17 new bladder cancers (0.4%), five of which did not present with haematuria. Patients found to have an elevated age-specific PSA had a 23.6% chance of being diagnosed with prostate cancer (3.8%).


CONCLUSIONS
The addition of abdominal ultrasound scanning, urine cytology and PSA testing as part of an LUTS assessment protocol can help to diagnose significant, potentially life-threatening conditions in up to 6.6% of patients. While the pick up rate of each individual condition is not higher in the LUTS patient than in the general population, the combined pick up rate may justify these additional investigations.
Patel
N S
NS
Department of Urology, Churchill Hospital, Oxford, UK. n1laysp@googlemail.com
Blick
C
C
Kumar
P V S
PV
Malone
P R
PR
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging; D002295:Carcinoma, Transitional Cell / Q000473:pathology; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000652:urine; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology; D053448:Prostatism / Q000175:diagnosis* / Q000209:etiology; D014463:Ultrasonography; D001749:Urinary Bladder Neoplasms / Q000473:pathology; D014545:Urinary Calculi / Q000000981:diagnostic imaging; D014556:Urine / Q000166:cytology; D055815:Young Adult
D017430:Prostate-Specific Antigen