Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Lower urinary tract symptoms in men

Kevin T McVary, MD, FACS
Rajiv Saini, MD
Section Editor
Michael P O'Leary, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


The term "lower urinary tract symptoms" (LUTS) is nonspecific. It has been used as a general term to refer to any combination of urinary symptoms or as a more specific term to refer to those symptoms primarily associated with overactive bladder (frequency, urgency, and nocturia). An international consensus conference defined LUTS to include symptoms relating to storage and/or voiding disturbances common among aging men [1]. This topic will review the symptoms, etiology, evaluation, diagnosis, and treatment of lower urinary tract dysfunction in men.

Discussions of incontinence, benign prostatic hyperplasia (BPH), and nocturia are presented separately.

(See "Urinary incontinence in men".)

(See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia".)

(See "Medical treatment of benign prostatic hyperplasia".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 01, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Abrams P, Chapple C, Khoury S, et al. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol 2009; 181:1779.
  2. Taylor BC, Wilt TJ, Fink HA, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology 2006; 68:804.
  3. Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology 2008; 72:318.
  4. Tam CA, Helfand BT, Erickson BA. The Relationship Between Diabetes, Diabetes Severity, Diabetes Biomarkers, and the Presence of Lower Urinary Tract Symptoms: Findings From the National Health and Nutrition Examination Survey. Urology 2017; 105:141.
  5. Gacci M, Corona G, Sebastianelli A, et al. Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis. Eur Urol 2016; 70:788.
  6. Bradley CS, Erickson BA, Messersmith EE, et al. Evidence of the Impact of Diet, Fluid Intake, Caffeine, Alcohol and Tobacco on Lower Urinary Tract Symptoms: A Systematic Review. J Urol 2017; 198:1010.
  7. Jones C, Hill J, Chapple C, Guideline Development Group. Management of lower urinary tract symptoms in men: summary of NICE guidance. BMJ 2010; 340:c2354.
  8. Pöyhönen A, Häkkinen JT, Koskimäki J, et al. Natural course of lower urinary tract symptoms in men not requiring treatment--a 5-year longitudinal population-based study. Urology 2014; 83:411.
  9. Helfand BT, McVary KT, Meleth S, et al. The relationship between lower urinary tract symptom severity and sleep disturbance in the CAMUS trial. J Urol 2011; 185:2223.
  10. Laumann EO, Kang JH, Glasser DB, et al. Lower urinary tract symptoms are associated with depressive symptoms in white, black and Hispanic men in the United States. J Urol 2008; 180:233.
  11. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61:37.
  12. Schatzl G, Temml C, Waldmüller J, et al. A comparative cross-sectional study of lower urinary tract symptoms in both sexes. Eur Urol 2001; 40:213.
  13. Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001; 87:760.
  14. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol 2003; 20:327.
  15. Irwin DE, Milsom I, Kopp Z, et al. Impact of overactive bladder symptoms on employment, social interactions and emotional well-being in six European countries. BJU Int 2006; 97:96.
  16. Kaplan SA, Roehrborn CG, Rovner ES, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 2006; 296:2319.
  17. de Groat WC. A neurologic basis for the overactive bladder. Urology 1997; 50:36.
  18. Abdel-Aziz KF, Lemack GE. Overactive bladder in the male patient: bladder, outlet, or both? Curr Urol Rep 2002; 3:445.
  19. Lee JY, Kim DK, Chancellor MB. When to use antimuscarinics in men who have lower urinary tract symptoms. Urol Clin North Am 2006; 33:531.
  20. Finkbeiner A, Lapides J. Effect of distension on blood flow in dog's urinary bladder. Invest Urol 1974; 12:210.
  21. Lin AT, Chen MT, Yang CH, Chang LS. Blood flow of the urinary bladder: effects of outlet obstruction and correlation with bioenergetic metabolism. Neurourol Urodyn 1995; 14:285.
  22. Lemack GE, Burkhard F, Zimmern PE, et al. Physiologic sequelae of partial infravesical obstruction in the mouse: role of inducible nitric oxide synthase. J Urol 1999; 161:1015.
  23. Uvelius B, Arner A. Changed metabolism of detrusor muscle cells from obstructed rat urinary bladder. Scand J Urol Nephrol Suppl 1997; 184:59.
  24. Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 2006; 49:651.
  25. Speakman MJ, Brading AF, Gilpin CJ, et al. Bladder outflow obstruction--a cause of denervation supersensitivity. J Urol 1987; 138:1461.
  26. Steers WD. Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol 2002; 4 Suppl 4:S7.
  27. Gratzke C, Bachmann A, Descazeaud A, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015; 67:1099.
  28. Wuerstle MC, Van Den Eeden SK, Poon KT, et al. Contribution of common medications to lower urinary tract symptoms in men. Arch Intern Med 2011; 171:1680.
  29. D'Silva KA, Dahm P, Wong CL. Does this man with lower urinary tract symptoms have bladder outlet obstruction?: The Rational Clinical Examination: a systematic review. JAMA 2014; 312:535.
  30. International Consultation on Incontinence Modular Questionaire (ICIQ). Available at: www.iciq.net/ICIQ.MLUTS.html (Accessed on April 10, 2009).
  31. McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185:1793.
  32. MacDiarmid S, Rogers A. Male overactive bladder: the role of urodynamics and anticholinergics. Curr Urol Rep 2007; 8:66.
  33. Porru D, Jallous H, Cavalli V, et al. Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressure-flow studies in the preoperative evaluation of symptomatic BPH. Eur Urol 2002; 41:246.
  34. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 2003; 170:530.
  35. Bright E, Oelke M, Tubaro A, Abrams P. Ultrasound estimated bladder weight and measurement of bladder wall thickness--useful noninvasive methods for assessing the lower urinary tract? J Urol 2010; 184:1847.
  36. Dmochowski RR. Bladder outlet obstruction: etiology and evaluation. Rev Urol 2005; 7 Suppl 6:S3.
  37. Kaplan SA, Ikeguchi EF, Santarosa RP, et al. Etiology of voiding dysfunction in men less than 50 years of age. Urology 1996; 47:836.
  38. Lim CS, Abrams P. The Abrams-Griffiths nomogram. World J Urol 1995; 13:34.
  39. Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 1999; 84:14.
  40. Dmochowski R. Antimuscarinic therapy in men with lower urinary tract symptoms: what is the evidence? Curr Urol Rep 2006; 7:462.
  41. Burgio KL, Goode PS, Johnson TM, et al. Behavioral versus drug treatment for overactive bladder in men: the Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial. J Am Geriatr Soc 2011; 59:2209.
  42. Brown CT, Yap T, Cromwell DA, et al. Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ 2007; 334:25.
  43. Gormley GJ, Stoner E, Bruskewitz RC, et al. The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group. N Engl J Med 1992; 327:1185.
  44. Roehrborn CG, Boyle P, Nickel JC, et al. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002; 60:434.
  45. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm258529.htm (Accessed on June 13, 2011).
  46. Lepor H, Williford WO, Barry MJ, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 1996; 335:533.
  47. Debruyne FM, Jardin A, Colloi D, et al. Sustained-release alfuzosin, finasteride and the combination of both in the treatment of benign prostatic hyperplasia. European ALFIN Study Group. Eur Urol 1998; 34:169.
  48. Sandhu JS, Vaughan ED Jr. Combination therapy for the pharmacological management of benign prostatic hyperplasia: rationale and treatment options. Drugs Aging 2005; 22:901.
  49. MacDiarmid SA, Peters KM, Chen A, et al. Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: randomized, double-blind, placebo-controlled study. Mayo Clin Proc 2008; 83:1002.
  50. McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349:2387.
  51. Roehrborn CG, Siami P, Barkin J, et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol 2008; 179:616.
  52. Anderson KE. Pharmacology of lower urinary tract smooth muscles and penile erectile tissues. Pharmacol Rev 1993; 45:253.
  53. McGuire, EJ, Savastano, JA. Effect of alpha adrenergic blockade and anticholinergic agents on the decentralized primate bladder. Neurourol Urodyn 1985; 4:139.
  54. Andersson KE, Wein AJ. Pharmacologic Management of Storage and Emptying Failure. In: Campbell-Walsh Urology, 9th ed, Wein AJ, Kavoussi LR, Novick AC, et al (Eds), Saunders Elsevier, Philadelphia 2007. p.2091.
  55. Bonner TI. The molecular basis of muscarinic receptor diversity. Trends Neurosci 1989; 12:148.
  56. Levin RM, Ruggieri MR, Wein AJ. Identification of receptor subtypes in the rabbit and human urinary bladder by selective radio-ligand binding. J Urol 1988; 139:844.
  57. Appell RA, Sand P, Dmochowski R, et al. Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study. Mayo Clin Proc 2001; 76:358.
  58. Diokno AC, Appell RA, Sand PK, et al. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clin Proc 2003; 78:687.
  59. Haab F, Stewart L, Dwyer P. Darifenacin, an M3 selective receptor antagonist, is an effective and well-tolerated once-daily treatment for overactive bladder. Eur Urol 2004; 45:420.
  60. Chapple CR, Rechberger T, Al-Shukri S, et al. Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int 2004; 93:303.
  61. Gupta SK, Sathyan G. Pharmacokinetics of an oral once-a-day controlled-release oxybutynin formulation compared with immediate-release oxybutynin. J Clin Pharmacol 1999; 39:289.
  62. MacDiarmid SA, Ellsworth PI, Ginsberg DA, et al. Safety and efficacy of once-daily trospium chloride extended-release in male patients with overactive bladder. Urology 2011; 77:24.
  63. Nabi G, Cody JD, Ellis G, et al. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev 2006; :CD003781.
  64. Staskin D, Sand P, Zinner N, et al. Once daily trospium chloride is effective and well tolerated for the treatment of overactive bladder: results from a multicenter phase III trial. J Urol 2007; 178:978.
  65. Staskin DR. Trospium chloride: Distinct among other anticholinergic agents available for the treatment of overactive bladder. Urol Clin North Am 2006; 33:465.
  66. Madhuvrata P, Cody JD, Ellis G, et al. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev 2012; 1:CD005429.
  67. Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 2006; 175:999.
  68. Athanasopoulos A, Gyftopoulos K, Giannitsas K, et al. Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 2003; 169:2253.
  69. Hao N, Tian Y, Liu W, et al. Antimuscarinics and α-blockers or α-blockers monotherapy on lower urinary tract symptoms--a meta-analysis. Urology 2014; 83:556.
  70. Maman K, Aballea S, Nazir J, et al. Comparative efficacy and safety of medical treatments for the management of overactive bladder: a systematic literature review and mixed treatment comparison. Eur Urol 2014; 65:755.
  71. Liu L, Zheng S, Han P, Wei Q. Phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. Urology 2011; 77:123.
  72. Gacci M, Corona G, Salvi M, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2012; 61:994.
  73. Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA 1987; 257:3076.
  74. Ng CK, Gonzalez RR, Te AE. Refractory overactive bladder in men: update on novel therapies. Curr Urol Rep 2006; 7:456.
  75. Van Venrooij GE, Van Melick HH, Eckhardt MD, Boon TA. Correlations of urodynamic changes with changes in symptoms and well-being after transurethral resection of the prostate. J Urol 2002; 168:605.
  76. Leng WW, Davies BJ, Tarin T, et al. Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol 2004; 172:1379.
  77. Cohen BL, Rivera R, Barboglio P, Gousse A. Safety and tolerability of sedation-free flexible cystoscopy for intradetrusor botulinum toxin-A injection. J Urol 2007; 177:1006.
  78. Duthie J, Wilson DI, Herbison GP, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev 2007; :CD005493.