Introduction

A recommendation on phosphodiesterase‑5 inhibitors has been added to section 1.4 on drug treatment. A research recommendation on phosphodiesterase‑5 inhibitors has been added to section 2.5. The addendum contains details of the methods and evidence used to develop these recommendations.

Lower urinary tract symptoms (LUTS) comprise storage, voiding and post‑micturition symptoms affecting the lower urinary tract. There are many possible causes of LUTS such as abnormalities or abnormal function of the prostate, urethra, bladder or sphincters. In men, the most common cause is benign prostate enlargement (BPE), which obstructs the bladder outlet. BPE happens when the number of cells in the prostate increases, a condition called benign prostatic hyperplasia. Other conditions that can cause LUTS include detrusor muscle weakness or overactivity, prostate inflammation (prostatitis), urinary tract infection, prostate cancer and neurological disease. This clinical guideline will advise on the effective evidence‑based management of LUTS in men.

LUTS in men are best categorised into voiding, storage or post‑micturition symptoms to help define the source of the problem. Voiding symptoms include weak or intermittent urinary stream, straining, hesitancy, terminal dribbling and incomplete emptying. Storage symptoms include urgency, frequency, urgency incontinence and nocturia. The major post‑micturition symptom is post‑micturition dribbling, which is common and bothersome. Although LUTS do not usually cause severe illness, they can considerably reduce men's quality of life, and may point to serious pathology of the urogenital tract.

LUTS are a major burden for the ageing male population. Age is an important risk factor for LUTS and the prevalence of LUTS increases as men get older. Bothersome LUTS can occur in up to 30% of men older than 65 years. This is a large group potentially requiring treatment.

Because uncertainty and variation exist in clinical practice, this guideline gives clear recommendations on diagnosing, monitoring and treating LUTS.

The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual men.

Recommendations about medicines

The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some medicines for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information. Where recommendations have been made for the use of medicines outside their licensed indications ('off‑label use'), these medicines are marked with a footnote in the recommendations.

  • National Institute for Health and Care Excellence (NICE)