The management of lower urinary tract symptoms in men

Summary points
Lower urinary tract symptoms (LUTS) in men have many causes and are often multifactorial
A full assessment helps in making a diagnosis and avoids the assumption that LUTS in all men are due to benign prostatic hyperplasia (BPH)
Frequency volume charts are underused but often provide important diagnostic clues
Lifestyle measures, in particular altering fluid intake, can be useful for men with LUTS
α blockers are the usual treatment for LUTS due to BPH, and antimuscarinics for overactive bladder
5 α reductase inhibitors reduce the risk of clinical progression and should be targeted at those at high risk of clinical progression
A range of surgical options are available for men who fail initial medical management
Lower urinary tract symptoms (LUTS) are common in men and increase in frequency and severity with age. Over one third of men aged 50 or more are living with moderate to severe symptoms, equating to 3.4 million men in the United Kingdom alone and 24 million in countries of the European Union.1 Most men with LUTS can be managed effectively in primary care, with either conservative lifestyle measures or medical treatment.2 We discuss the causes of LUTS in men and summarise the current evidence on assessment and management of patients.

Sources and selection criteria
We performed a search of PubMed to identify peer reviewed original articles, meta-analyses, and reviews, using the search terms “lower urinary tract symptoms”, “benign prostatic hyperplasia”, and “overactive bladder”. In addition we reviewed national and international guidelines and the Cochrane Collaboration and clinical evidence databases. We considered only papers written in English, with emphasis on more recent articles where available and where we deemed the scientific validity to be sufficient.