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 the metabolic syndrome is linked to LUTS.Evaluation of LUTS should follow a structured system, with symptom scores and frequency/volume charts used in initial assessment. Several features have been identified as risk factors for progression of LUTS and risk stratification using these factors can aid in planning management. For example, a high-normal prostate-specific antigen may suggest a higher risk of progression to acute urinary retention.Many patients with LUTS will require no treatment. If indicated, first-line treatment of LUTS should be conservative, then medical, involving selective α-blockers, 5-α reductase inhibitors, antimuscarinics, or a combination of these. Phosphodiesterase-5 inhibitors may improve symptom scores and quality of life but require further investigation before routine use in LUTS.