Management of lower urinary tract symptoms in men: summary of NICE guidance

Lower urinary tract symptoms (LUTS) in men are related to problems with storage and voiding of urine and can occur after micturition. The many causes of LUTS include abnormalities or abnormal function of the bladder, prostate, urethra, or sphincters. The prevalence of LUTS increases as men get older, with about 30% of men aged 65 years and older having troublesome symptoms,1 which may require treatment. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on LUTS.2 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. Lower urinary tract symptoms have been categorised according to the three stages of the bladder cycle3: storage (when filling of the bladder occurs), voiding (when the bladder actively expels its contents), and post micturition (immediately after voiding, while returning to the storage stage) (box). #### Categories of lower urinary tract symptoms3 ##### Storage (also symptoms of overactive bladder) ##### Voiding ##### Post-micturition ### Initial assessment At initial assessment (in any setting and by a healthcare professional without specific training in managing LUTS in men) take the following actions.