A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting

• Published in: International journal of clinical practice (Esher) Vol. 61; no. 9; pp. 1535 - 1546
• Main Authors: Rosenberg, M. T., Staskin, D. R., Kaplan, S. A., MacDiarmid, S. A., Newman, D. K., Ohl, D. A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2007; Blackwell
• Subjects: Aged; Algorithms; Biological and medical sciences; Diagnosis, Differential; Drug Therapy, Combination; General aspects; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prevalence; Primary Health Care; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - drug therapy; Urinary Bladder, Overactive - complications; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urination Disorders - diagnosis; Urination Disorders - drug therapy; Urination Disorders - etiology; Medicine; Voiding dysfunction; Evaluation; Urinary system disease; Guide; Treatment; Primary health care; Male; Urinary tract disease; Lower urinary tract symptoms
• ISSN: 1368-5031; 1742-1241
• DOI: 10.1111/j.1742-1241.2007.01491.x

Summary Aims:  Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results:  Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion:  This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion:  Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically.