Male Lower Urinary Tract Symptoms

Lower urinary tract symptoms (LUTS) are the cause of considerable bother to our patients and impact greatly on patient quality of life. They are a commonly encountered complaint in primary care. Symptoms can be more obstructive, like hesitancy and poor flow, when they are called voiding symptoms and/or more irritative such as urgency and frequency when they come more from the storage phase of micturition. Increasing evidence shows that the majority of patients can be safely treated in primary care and that first-line treatment can be safely started after a good history, a focused examination, and a few basic investigations. Only when the risky “red flag” symptoms have been identified or when patients fail to respond to first-line therapy is a referral for specialist investigation required. All patients should be offered advice on lifestyle adjustments; a trial of conservative management alone with review at 6 months is appropriate if symptoms are not currently bothersome. In patients with bothersome symptoms, the first-line medical treatment is an alpha-blocker, which should be combined with a 5-alpha reductase inhibitor in the presence of risk factors for progressive disease. Second-line therapies may be added in at 6-week review.