Lower Urinary Tract Symptoms in Men

Key points

• Male lower urinary tract symptoms (LUTS) are common and increase with age, but LUTS are not synonymous with benign prostatic enlargement and should not be attributed automatically to the prostate.
• Urinalysis/dipstick is part of initial assessment to look for blood, glucose, protein, leucocytes and nitrites and to help identify infection or other pathology.
• Digital rectal examination (DRE) may assess prostate size, consistency and abnormalities and should be interpreted with the rest of the clinical assessment.
• PSA: offer/discuss PSA testing when clinically appropriate, including when prostate cancer is a concern or when the result would change management; explain benefits, limitations and potential consequences before testing.
• Frequency–volume charts are useful particularly when storage symptoms/nocturia are prominent, helping distinguish frequency, polyuria, nocturia and nocturnal polyuria.
• MRCP discriminator: LUTS + normal urinalysis/DRE without red flags often suggests benign prostatic obstruction, but haematuria, recurrent infection, retention, abnormal DRE or high PSA changes the pathway.
• Do not use prostate size alone to explain LUTS severity.