Initial management of lower urinary tract symptoms and bladder outlet obstruction

Lower urinary tract symptoms (LUTS) affect more than 60% of men and women aged over 40. Symptoms may be classed as storage, voiding or post-micturition and have a variety of systemic, neurological, drug-related or urological causes. There is growing evidence that metabolic syndrome is linked to LUTS. Initial evaluation of LUTS should follow a structured system, with symptom scores and frequency/volume charts. Several features have been identified as risk factors for progression of LUTS and stratification using these factors can aid in planning management. For example, older age and a high-normal concentration of prostate-specific antigen may suggest a higher risk of progression to acute urinary retention. Many patients with LUTS will require no treatment. For those who do, the initial approach should be conservative, with lifestyle changes; this can be followed where necessary by drug treatment using selective α-adrenoceptor blockers, 5-α reductase inhibitors, antimuscarinics, mirabegron, or a combination of these. Phosphodiesterase-5 inhibitors can also improve symptom scores and quality of life, and may become part of the routine management of LUTS.