The diagnostic value of abdominal ultrasound, urine cytology and PSA testing in the LUTS clinic

Nilay S Patel (1) , Christopher Blick (1) , Pvs Kumar (2) , Peter Malone (2)

1 Department of Urology
2 Department of Urology

Introduction – Lower urinary tract symptoms (LUTS) affect 18-26% of men aged 40-79, 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, a prostate specific antigen (PSA) blood test and urine cytology during the assessment of males presenting with LUTS in order 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 ultrasound scans resulted in the incidental diagnosis of 4 renal carcinomas (0.1%), 45 AAAs (incidence = 1.1%) and 44 urinary tract calculi (1.1%). Urine cytology testing and bladder ultrasound scans helped diagnose 17 new bladder cancers (0.4%), 5 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%). Conclusion - The addition of abdominal ultrasound scanning, urine cytology and PSA testing as part of a LUTS assessment protocol can help to diagnose significant, potentially life threatening conditions in up to 6.6% of patients. Whilst the pick up rate of each individual condition is no higher in the LUTS patient than in the general population, the combined pick up rate may justify these additional investigations.

Mots clés: Medicine

Nilay S Patel, Christopher Blick, Pvs Kumar, Peter Malone. The diagnostic value of abdominal ultrasound, urine cytology and PSA testing in the LUTS clinic. International Journal of Clinical Practice, 2009, 63 (12), pp.1734. ⟨10.1111/j.1742-1241.2009.02138.x⟩. ⟨hal-00532544⟩