Practice 10-Minute Consultation

Lower urinary tract symptoms in an older man

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1493 (Published 18 April 2017) Cite this as: BMJ 2017;357:j1493
  1. Maria Vedanayagam, urology specialist registrar1,
  2. Amit Kumar, general practitioner2,
  3. Sanjeev Madaan, consultant urological surgeon1
  1. 1Darent Valley Hospital, Dartford DA2 8DA, UK
  2. 2White Horse Surgery, Northfleet, Gravesend DA11 8BZ, UK
  1. Correspondence to: S Madaan sanjeev.madaan{at}nhs.net
  • Accepted 16 March 2017

What you need to know

  • Lower urinary tract symptoms in men are common and increase with age

  • For bothersome urine voiding symptoms secondary to suspected benign prostatic enlargement, trial of an α blocker or 5α-reductase inhibitor, or both

  • For bothersome urine storage symptoms, trial an anticholinergic or β3 agonist

A 65 year old man comes to see you with problems urinating. He feels the need to pass urine often, and it takes a long time to void when he does.

Lower urinary tract symptoms in men are common and increase with age.1 There is an estimated prevalence of >50% in men over 50 years old.2 Between the ages of 40 and 79 years, the prevalence of moderate to severe symptoms increases by 9.8% per decade.3 There is also a strong association of lower urinary tract symptoms with metabolic syndrome (including obesity, diabetes, and hypertension).45

Lower urinary tract symptoms in men are most commonly due to benign prostatic enlargement, which can cause bladder outflow obstruction.67 However, not all men with benign prostatic enlargement will have bothersome symptoms.6 Lower urinary tract symptoms can interfere with general wellbeing, sleep, and sexual activity. They are an independent risk factor for sexual dysfunction in men over the age of 50 years.2 Some patients who seek medical attention may be …

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