Lower Urinary Tract Symptoms & Incontinence Specialist, London
Expert assessment and treatment of bladder symptoms and urinary incontinence in men and women — from lifestyle measures and medication through to minimally invasive and surgical solutions.
Important: Urinary symptoms and incontinence are among the most common — and most under-reported — problems in both men and women. Many patients live with them for years, assuming nothing can be done. This is not the case. Effective treatments exist at every stage, from simple lifestyle measures to minimally invasive procedures. There is no need to simply cope.
What are lower urinary tract symptoms?
Lower urinary tract symptoms (LUTS) is the umbrella term for any symptoms relating to the bladder, urethra, and pelvic floor. They affect men and women of all ages and can significantly impact quality of life, sleep, work, and relationships. They are broadly divided into three categories.
Symptoms in men and women
While many LUTS are shared between the sexes, the underlying causes and most common presentations differ. Understanding which symptoms you have helps guide the assessment.
In men, LUTS are most commonly caused by benign prostate enlargement (BPH) or overactive bladder, though other causes — including stricture disease, bladder dysfunction, or rarely bladder cancer — must also be considered. Assessment in men includes prostate evaluation and measurement of urine flow rate.
Women
UrgencyLeaking on coughing/sneezingFrequencyNocturiaUrgency incontinenceStress incontinencePelvic pressureRecurrent UTIs
In women, the most common presentation is stress urinary incontinence (leaking on exertion), overactive bladder, or a combination of both (mixed incontinence). Pelvic floor weakness, childbirth history, and menopause are important contributing factors. Pelvic organ prolapse may coexist and compound symptoms.
Types of urinary incontinence
Incontinence — involuntary leakage of urine — has distinct subtypes, each with different causes and treatment pathways. Accurate classification guides effective management.
Stress incontinence
Leakage triggered by physical exertion — coughing, sneezing, laughing, lifting, or exercise. Caused by weakness of the urethral sphincter or pelvic floor. The most common type in women; also occurs in men after prostate surgery.
Leaking when you sneeze or run
Urgency incontinence
An overwhelming, sudden urge to pass urine that cannot be deferred, resulting in leakage before reaching the toilet. Caused by overactive bladder (OAB) — involuntary bladder muscle contractions. Affects both men and women.
Can't make it to the toilet in time
Mixed incontinence
A combination of stress and urgency incontinence — the most common presentation in women seen in a specialist clinic. Both components require separate assessment and treatment, often with a combined approach.
Both urgency and exertional leakage
How LUTS and incontinence are assessed
A structured assessment is essential to distinguish between the different causes of LUTS and to direct the right treatment. Investigation is tailored to symptoms, sex, and clinical findings.
1
Detailed history and validated symptom questionnaire
A thorough review of symptom type, duration, and impact on quality of life, completed alongside a validated score such as the IPSS (men) or ICIQ (for incontinence). A bladder diary — recording fluid intake and voiding pattern over three to seven days — is invaluable for storage symptoms and nocturia.
2
Physical examination
In men, digital rectal examination to assess prostate size and consistency. In women, pelvic examination to assess pelvic floor strength, prolapse, and urethral support. A focused neurological examination where relevant.
3
Urine tests and blood tests
Urinalysis to exclude infection, haematuria, and glycosuria. PSA in men where prostate cancer assessment is relevant. Renal function tests if upper tract involvement or surgical treatment is being considered.
4
Uroflowmetry and post-void residual
Non-invasive urine flow rate measurement (uroflowmetry) and bladder ultrasound to measure how much urine remains after voiding. Performed prior to any treatment — essential for voiding symptoms and before surgery.
5
Imaging
Ultrasound of the kidneys and bladder to assess the upper tract, bladder wall thickness, and prostate volume. CT or MRI where further detail is required.
6
Flexible cystoscopy
Direct camera inspection of the bladder — performed where haematuria is present, symptoms suggest bladder pathology, or prior to surgical intervention. A quick, well-tolerated outpatient procedure.
7
Urodynamic studies
Pressure-flow studies measuring bladder and sphincter function in detail. Performed selectively — particularly before surgical treatment for incontinence or where the underlying cause of LUTS is uncertain
Treatment pathways
Treatment always begins with the least invasive effective option, stepping up where needed. The pathways for men and women differ significantly, reflecting the different underlying causes.
Medication — alpha-blockers for voiding symptoms, antimuscarinics or beta-3 agonists (mirabegron) for overactive bladder, 5-alpha reductase inhibitors for larger prostates
Pelvic floor physiotherapy — for urgency, post-micturition dribble, and post-prostatectomy incontinence
Minimally invasive and surgical options — for BPH causing obstruction or where medical treatment is inadequate. See the prostate enlargement page for the full range of procedures
Cystoscopy and Botox — for refractory urgency incontinence or OAB
Sacral neuromodulation (subspecialty practice) — for refractory overactive bladder or urgency incontinence not responding to medication
Pelvic floor muscle training — first-line for stress and mixed incontinence. Supervised physiotherapy achieves significantly better outcomes than unsupervised exercise
Medication — antimuscarinics or mirabegron for overactive bladder; topical oestrogen in post-menopausal women with urogenital atrophy
Cystoscopy and Botox — for refractory urgency incontinence or OAB
Sacral neuromodulation (subspecialty practice) — for refractory urgency incontinence or OAB
Robotic surgical treatment (subspecialty practice) — for stress incontinence or mixed incontinence not controlled by conservative measures.
Surgical treatment for female stress incontinence
Collaborative specialist practice
Robotic continence surgery for female urinary incontinence constitutes subspecialty practice
Mr Sri does not perform female incontinence surgery himself, but works closely with & mentors distinguished specialist colleagues who deliver robotic functional reconstructive surgery for female stress and mixed urinary incontinence. This includes robotic Burch colposuspension and robotic sacrocolpopexy for associated pelvic organ prolapse — procedures that offer the precision benefits of robotic surgery in delicate pelvic anatomy.
Where a female patient requires surgical intervention for incontinence, Mr Sri ensures a direct referral to the most appropriate specialist, with continuity of care and shared follow-up where relevant. Please contact us to discuss your needs and we will guide you to the right pathway.
Many patients delay seeking help — either from embarrassment, or in the belief that urinary symptoms are simply part of ageing. Neither is a reason to continue without assessment. You should see a specialist if any of the following apply.
If you have noticed blood in your urine alongside any of the above symptoms, this requires a separate and urgent assessment pathway.
No. While LUTS and incontinence become more common with age, they are not inevitable — and they are not something patients should simply accept. Effective treatments are available at every age and for every severity of symptoms. The first step is an accurate assessment.
Will I definitely need surgery?
The majority of patients are successfully managed with lifestyle measures, physiotherapy, or medication alone. Surgery is only considered when these approaches have been tried and have not provided sufficient improvement, or when there is a clear structural cause — such as prostate obstruction — that benefits from a procedural solution. Some patients opt to proceed directly to surgery for their urinary symptoms.
What is overactive bladder?
Overactive bladder (OAB) is a syndrome characterised by urgency — a sudden, compelling need to pass urine — usually with frequency and nocturia, with or without urgency incontinence. It is caused by involuntary contractions of the bladder muscle and affects both men and women. It is treatable with a combination of bladder retraining, pelvic floor exercises, and medication.
I had a baby several years ago and have leaked ever since — can this be treated?
Yes. Post-partum stress urinary incontinence is one of the most common forms of incontinence in women, and it responds well to treatment. Supervised pelvic floor physiotherapy is the first step and works for many women. Where symptoms persist, further treatment options — including minimally invasive and surgical approaches — are available and highly effective.
I am a man with urinary symptoms — where do I start?
A specialist consultation is the starting point. For men, the assessment will determine whether symptoms are due to prostate enlargement, overactive bladder, or another cause — and direct the most appropriate treatment. If your GP has found a raised PSA, this should also be assessed — see the raised PSA page for more detail.
Do I need a GP referral?
No — you can self-refer directly. If you already have investigation results or a letter from your GP, please bring these to your consultation as they will be helpful.
Mr Sri assesses and manages the full range of lower urinary tract symptoms in men and women, from initial investigation through to medical and surgical treatment. His practice includes the management of male LUTS — including BPH-related voiding dysfunction and overactive bladder — and referral pathways for female incontinence surgery delivered in collaboration with specialist robotic functional urology colleagues. He sees patients at three private hospital locations in London and Surrey.
Clinic locations
Mr Sri sees patients at three private hospital locations in and around London.
Spire St Anthony's
801 London Road Cheam, Surrey SM3 9DW
Tel: 020 8337 6691
Nuffield Parkside
53 Parkside Wimbledon SW19 5NX
Tel: 020 8971 8000
HCA Princess Grace
18 Devonshire Street Marylebone W1G 7AF
Tel: 020 379 77248
Bothered by urinary symptoms?
Same-week appointments available. No GP referral required. Self-pay and all major insurers accepted.
