October 2011


Lower urinary tract symptoms

Current management in older men

Volume 40, No.10, October 2011 Pages 758-767

Mohan Arianayagam

Ranjan Arianayagam

Prem Rashid


Lower urinary tract symptoms are a common problem in men and the incidence of these symptoms increases with age.


This article provides an update on the evaluation and treatment of lower urinary tract symptoms in older men. In particular, we describe current nomenclature, diagnosis, the International Prostate Symptom Score, and currently available medical and surgical treatments as well as indications for referral to a urologist.


Lower urinary tract symptoms may be divided into voiding and storage, and men may present with a combination of the two symptom groups. Voiding symptoms include weak stream, hesitancy, and incomplete emptying or straining and are usually due to enlargement of the prostate gland. Storage symptoms include frequency, urgency and nocturia and may be due to detrusor overactivity. In elderly men who present with lower urinary tract symptoms, indications for early referral to a urologist include haematuria, recurrent infections, bladder stones, urinary retention and renal impairment. In uncomplicated cases, medical therapy can be instituted in the primary care setting. Options for medical therapy include alpha blockers to relax the smooth muscle of the prostate, 5 alpha reductase inhibitors to shrink the prostate, and antimuscarinics to relax the bladder. The International Prostate Symptom Score is beneficial in assessing symptoms and response to treatment. If symptoms progress despite medical therapy or the patient is unable to tolerate medical therapy, urological referral is warranted.

Lower urinary tract symptoms (LUTS) are a common problem in men and may impact significantly on quality of life. Symptoms may be divided into: voiding, storage, or a combination of both.1 Incidence increases with age (Figure 1). In this article we provide an approach to nonneurogenic LUTS in older men and discuss management strategies. In particular, we focus on pharmacological therapies as these are easily commenced in the primary care setting.

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Please note this article has been updated since publication. Table 2, on page 759 of the article 'Lower urinary tract symptoms – current management in older men' by Arianayagam et al (AFP October 2011), contains an error. The contents of the left hand column of the table have been swapped so that the causes of ‘Storage symptoms’ listed are in fact the causes of ‘Voiding symptoms’ and vice versa. Common causes of lower urinary tract symptoms in men include: - storage symptoms: urinary tract infection, bladder calculi, urothelial carcinoma, overactive bladder - voiding symptoms: benign prostatic enlargement, bladder neck stenosis, urethral stricture, poor detrusor contractility. The updated table appears in this version. The Editors apologise for any inconvenience this error many have caused.

Correspondence afp@racgp.org.au

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