Lower urinary tract symptoms (LUTS) are prevalent and bothersome symptoms, both for males and females.1 Most attention is given to LUTS in older males because in this group the prevalence is high and doctor visits are more common.2 The possibilities for physicians — both GPs as well as urologists — to encounter LUTS in daily practice are limited. The 2010 guideline The Management of Lower Urinary Tract Symptoms in Men, by the National Institute for Health and Clinical Excellence (NICE), presents an authority-based algorithm for this patient group. Education about the natural history of LUTS and the reassurance that LUTS are not caused by prostate cancer are important specific anchors for GPs and their patients.3,4 Treatment options for GPs are restricted to physiotherapy, alpha-blocking agents, 5-alpha reductase inhibitors, anticholinergics, or combination therapy.3 Urologists may offer operative treatment in those with severe symptoms not responding to non-invasive treatment.
The efficacy and effectiveness of treatments for LUTS in older males are limited.3 The probable explanation is that LUTS are multifactorial in their origin, whereas the therapeutic approach is simplistic, targeting specific organs.
DETERMINING THE CAUSE
Prostatic pathophysiology — especially prostate enlargement and prostate obstruction — was long thought to be the explanation for (nearly all) LUTS in older males and most of the drugs approved for LUTS in males aim to influence prostate function. Evidence is growing that this is a misconception. It is now clear that prostate enlargement or benign prostate obstruction is not the common cause of male LUTS.5 Many men with LUTS do not have prostate enlargement nor prostatic obstruction, whereas many men with an enlarged …