Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

Table 1 Conclusions for epidemiology section

UI has a prevalence of 21%-32% in elderly men

OAB symptom cluster occurs in 10%-25%of men

Age is the strongest risk factor for LUTS

LUTS: Lower urinary tract symptoms; OAB: Overactive bladder; UI: Urinary incontinence.

Table 2 Conclusions for assessment section

History and examination are mandatory

Frequency volume chart is recommended for 3-7 d

The IPSS is recommended but it is not disease specific

Urine dipstick assessment is recommended to exclude serious underlying conditions

Serum creatinine estimation is still recommended

PSA should be performed according to national guidelines

Flow rate and post void residual estimation are recommended

Prostatic protrusion/angle and bladder weight/thickness are inferior to cystometry

Cystometry should be limited to men where a finding will change management

IPSS: International Prostate Symptom Score.

Table 3 Conclusions for nocturia section

Nocturia frequency more than twice increases morbidity and mortality

It is important to differentiate nocturia from nocturnal polyuria, global polyuria and sleep disorders

Drugs shown to improve nocturia include alpha antagonists, and antimuscarinics, which may be combined

No overall benefit has been shown for 5-α reductase inhibitors but these may be useful for some men

Desmopressin has been shown to be beneficial but caution should be applied in renal failure and elderly patients

Diuretics are useful in specific cases

Benzodiazepines may be used to improve sleep quality

Table 4 Conclusions for medical therapies section

Phytotherapies are not recommended due to evidence from meta-analysis or poor RCT data

Alpha antagonists are recommended

Antimuscarinic agents have mostly been trialled in women, but there is evidence to show their efficacy

Men in antimuscarinic trials have a post void residual of < 250 mL

Men with a PSA > 1.5 or prostate volume > 30 mL are more likely to benefit from a 5-α reductase inhibitor

Combination treatments may be suitable for some men

Discontinuation of the 5-α reductase inhibitor is not recommended as the symptoms are likely to return

Phosphodiesterase inhibitors may be used in men with a combination of LUTS and erectile dysfunction

LUTS: Lower urinary tract symptoms; RCTs: Randomized controlled trials.