Home / Services and specialties / Lower urinary tract symptoms (LUTS) pathway

Lower urinary tract symptoms (LUTS) pathway

A diagnostic pathway for men experiencing lower urinary tract symptoms.

Reviewed by Mr Jas Kalsi, Consultant Urologist and Male Fertility Expert

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About the LUTS pathway

LUTS (or lower urinary tract symptoms) in men refers to symptoms which may be related to a functional or structural problem in the prostate, bladder, or the urethra. The frequency with which men experience these symptoms increases with age.

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The main symptoms can be split into storage, voiding, and post-micturition categories.

  • Storage – urgency, daytime urinary frequency, night time frequency (nocturia), and urinary incontinence
  • Voiding – hesitancy, weak or intermittent urinary stream, straining, and incomplete emptying
  • Post-micturition – post-micturition dribble and the sensation of incomplete emptying.

Patients experiencing these symptoms will have a streamlined set of tests to allow a full assessment the issue.

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Diagnostic tests we offer

The LUTS pathway provides a comprehensive range of diagnostic tests to ensure our consultants can accurately assess and diagnose your condition. 

Blood tests

Our pathway offers three types of blood test to accurately assess your symptoms: PSA, eGFR and creatinine.  

Mid-stream urine sample (MSU)

This type of urine sample is taken mid-stream to prevent contamination from bacteria on the surrounding skin.

Multiparametric MRI (mpMRI) of the prostate

An mpMRI is a special type of MRI scan that produces a more detailed image of the prostate than a regular scan. 

Ultrasound of the renal tract

An ultrasound is an imaging procedure that uses sound waves to produce images of your renal tract.

Urine flow test

This test measures the flow rate of your urine and is used to check how the bladder and sphincter are working.

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Treatment for LUTS

Your consultant may decide that you can be suitably reassured or require either medical treatment or a surgical procedure following a review of your results.

All the options will be discussed with the patient after they have been fully carefully assessed. The most appropriate and effective treatment will be recommended by a specialist. The service is lead by Mr Jas Kalsi, who is a very experienced consultant urological surgeon and specialist in minimally invasive surgical techniques.

Some of the potential surgical options include:

  • Rezum – This innovative minimally invasive treatment uses steam to remove the enlarged part of your prostate. The steam is delivered to your prostate using an instrument inserted through your urethra while you are asleep. The steam energy then slowly (over the next 4-12 weeks) causes the obstructive prostate tissue to atrophy. There are 5 year multi-centre controlled trials to support this treatment.
  • Urolift – This is also a minimally invasive treatment. Small clips are inserted into the prostate to pull the prostate apart while you are asleep. This allows a larger diameter through which to pass urine. The success rate is similar to Rezum in the short term but with the need for a higher re-treatment rate at 3 years.
  • HoLEP (Holmium laser enucleation of the prostate) – The gold standard treatment for patients with large prostates (>80g) and those who cannot pass urine (in retention of urine). Through a telescope. A laser fibre using the new MOSES technology is used to carefully cut and remove excess prostate tissue that is blocking the flow of urine. Another instrument is then used to remove the prostate tissue. The removed tissue can then be analyzed to exclude any cancerous cells. This technique has durable long term results with a low side effect profile.
  • TURP (transurethral resection of the prostate) – TURP has been the standard of care surgical procedure that involves removing part of the prostate gland to alleviate the urinary symptoms associated with an enlarged prostate up 80g in size. The technique has been made safer and more effective using bipolar rather than monopolar diathermy.
  • Greenlight laser surgery uses a different laser frequency than the Holmium. The excess prostate tissue is vaporized (dissolved) without harming other healthy tissue. The slight disadvantage of this type of laser is that no tissue is sent for analysis.

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Private urologists in London

The LUTS pathway service is led by Mr Jas Kalsi, Consultant Urologist and Male Fertility Expert.

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Mr Tamer El-Husseiny

/ Consultant Urological Surgeon

Urology, General, Urinary tract stones

Clinical interests: Mr El-Husseiny is an experienced consultant urological surgeon, in addition to general urology he sub-specialises in the diagnosis and management of kidney stones, Endourology (minimally invasive surgery) such as ureteroscopy and laser stone fragmentation, PCNL (keyhole surgery for kidney stones) and is one of a handful of urologists in the country performing this complex procedure in the supine position and also performing his own access. HoLEP (Holmium Laser Enucleation of the Prostate), Urolift and Endourological management of upper tract urothelial cancer. He treats other upper tract abnormalities, including strictures and extrinsic obstruction and has special expertise in the use of different types of urological stents.

Languages spoken: Arabic/English

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Professor Rakesh Heer

/ Consultant Urological Surgeon

Urology

Clinical interests: Professor Heer has extensive experience across the full breadth of general urology. He has specialist interests focused on all aspects of management for prostate and bladder cancer. In particular, he has a reputable high volume robotic surgery practice for prostatectomy (removal of the prostate for cancer), cystectomy (removal of the bladder), and urinary tract reconstruction (ileal conduits and orthotopic bladders). Professor Heer provides excellent surgical outcomes, benchmarked against national standards (BAUS and National Prostate Cancer Audits). He also provides care for male sexual dysfunction, which can follow with these major surgeries.

Languages spoken: English

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Mr Jas Kalsi

/ Consultant Urologist and Male Fertility Expert

Urology

Clinical interests: Investigation and treatment of male lower urinary tract symptoms: Lead for Gold standard Holmium laser enucleation (HoLEP). Offers minimally invasive treatments such as including Rezum and Urolift. Investigation for raised PSA, haematuria and UTIs. Investigation and treatment of male sexual dysfunction including male fertility, erectile dysfunction, Peyronie’s disease and microsurgery for Varicoceles (enlarged veins around testes). Lead in management of scrotal lesions including testicular cancer.

Languages spoken: English/Hindi/Punjabi

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Mr Benjamin Lamb

/ Consultant Urological Surgeon

Urology, Robotic Surgery

Clinical interests: Prostate cancer; raised PSA; lower urinary tract symptoms (LUTS); urinary tract infection (UTI); blood in the urine (haematuria) and semen (haematospermia); scrotal/penile lumps; chronic pelvic pain.

Languages spoken: English

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Prof Asif Raza

/ Consultant Urological Surgeon

Urology, General, Urinary tract stones

Clinical interests: Keyhole kidney and laser stone surgery (endourology) prostate problems both benign and cancer related offering prostate cancer screening, prostate surgery including green light laser surgery for benign prostatic enlargement, all general urological conditions in men and women including urinary infections, blood in the urine, penile and testicular problems as well as bladder problems.

Languages spoken: English/Hindi/Punjabi/Urdu

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Mr Mathias Winkler

/ Consultant Urologist

Urology, General

Clinical interests: General Urology, urinary symptoms, prostate problems, scrotal lumps, blood in the urine, suspected cancer in kidney, prostate, bladder or testes, kidney stones, abnormal PSA, second opinion on cancer diagnosis and management and laraparaoscopic pelvic cancer surgery

Languages spoken: English/German

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Our locations

Cromwell Hospital

Cromwell Hospital

164-178 Cromwell Road
London SW5 0TU
United Kingdom

+44 (0)20 7460 5700

More about Cromwell Hospital >
Basinghall Clinic

Basinghall Clinic

4 Basinghall Street
London EC2V 5BQ
United Kingdom

+44 (0)20 7244 4891

More about Basinghall Clinic >
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Our telephone lines are open 8am to 8pm Monday to Friday and 8am to 2pm Saturdays.

 

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Please note - regrettably we are unable to answer specific medical questions or offer medical advice via email or telephone.