Initial Management of Lower Urinary Tract Symptoms and Bladder Outlet Obstruction

Lower urinary tract symptoms (LUTS) are a common presenting complaint for both men and women, affecting >60% of men and women aged >40 years. They encompass a wide range of aetiologies and can be an indicator of covert underlying pathologies such as obesity and metabolic syndrome. The initial assessment should focus on identifying the underlying cause and assessing the impact on quality of life aided by validated objective questionnaires. Risk factors have been identified that can predict the likelihood of progression of LUTS (e.g. urinary retention), such as age, moderately elevated prostate-specific antigen and prostate size. Initial management includes conservative and medical management, and not all patients require surgery. Identifying those at high risk of acute urinary retention helps in counselling and subsequent management decisions. Aside from lifestyle modification, medications include selective α-adrenoceptor blockers, 5α-reductase inhibitors, antimuscarinics, β3-agonists and phosphodiesterase-5 inhibitors, either as monotherapy or combination therapy.