title: Lower urinary tract symptoms - current management in older men.
abstract: BACKGROUND
  Lower urinary tract symptoms are a common problem in men and the incidence of these symptoms increases with age.
  
  
  OBJECTIVE
  This article provides an update on the evaluation and treatment of lower urinary tract symptoms in older men. In particular, we describe current nomenclature, diagnosis, the International Prostate Symptom Score, and currently available medical and surgical treatments as well as indications for referral to a urologist.
  
  
  CONCLUSIONS
  Lower urinary tract symptoms may be divided into voiding and storage, and men may present with a combination of the two symptom groups. Voiding symptoms include weak stream, hesitancy, and incomplete emptying or straining and are usually due to enlargement of the prostate gland. Storage symptoms include frequency, urgency and nocturia and may be due to detrusor overactivity. In elderly men who present with lower urinary tract symptoms, indications for early referral to a urologist include haematuria, recurrent infections, bladder stones, urinary retention and renal impairment. In uncomplicated cases, medical therapy can be instituted in the primary care setting. Options for medical therapy include alpha blockers to relax the smooth muscle of the prostate, 5 alpha reductase inhibitors to shrink the prostate, and antimuscarinics to relax the bladder. The International Prostate Symptom Score is beneficial in assessing symptoms and response to treatment. If symptoms progress despite medical therapy or the patient is unable to tolerate medical therapy, urological referral is warranted.
authors: Department of Urology, The University of Miami Miller School of Medicine, Florida, USA. m.arianayagam@yahoo.com
authors: Mohan
authors: M
authors: Arianayagam
authors: Ranjan
authors: R
authors: Arianayagam
authors: Prem
authors: P
authors: Rashid
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D011468:Prostatectomy; D057832:Watchful Waiting
chemical_list: D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D018727:Muscarinic Antagonists