Lower urinary tract symptoms

• Increased frequency of urination
• Increased urgency of urination
• Urge incontinence
• Excessive passage of urine at night

• Poor stream[8] (unimproved by straining)
• Hesitancy[8] (worsened if bladder is very full)
• Terminal dribbling[8]
• Incomplete voiding[8]
• Urinary retention[9]
• Overflow incontinence (occurs in chronic retention)[9]
• Episodes of near retention[9]

As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.[7] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[10] Also, recently a report of lower urinary tract symptoms even with malignant features in the prostate failed to be associated with prostate cancer after further laboratory investigation of the biopsy.[9]

Other treatments include lifestyle advice; for example, avoiding dehydration in recurrent cystitis.

Men with prostatic hypertrophy are advised to sit down whilst urinating.[17] A 2014 meta-analysis found that, for elderly males with LUTS, sitting to urinate meant there was a decrease in post-void residual volume (PVR, ml), increased maximum urinary flow (Qmax, ml/s), which is comparable with pharmacological intervention, and decreased the voiding time (VT, s).[18] The improved urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.[18]

Physical activity

Physical activity has been recommended as a treatment for urinary tract symptoms. A 2019 Cochrane review of six studies involving 652 men assessing the effects of physical activity alone, physical activity as a part of a self-management program, among others.[19] The evidence from this review states that there are important uncertainties whether physical activity is helpful in men experiencing urinary symptoms caused by benign prostatic hyperplasia.[19]

With benign prostatic enlargement causes of LUTS, people may be offered a variety of medications (as a single drug or combining them) when there are persistent moderate symptoms:[20]

• Alpha blockers
• 5-alpha reductase inhibitors
• Phosphodiesterase inhibitors
• Muscarinic receptor antagonists
• Plants extracts (phytotherapy)
• Beta-3 agonist

If medical treatment fails, or is not an option; a number of surgical techniques to destroy part or all of the prostate have been developed.

Surgical treatment of LUTS can include:

• Ablation procedures - used in treating both bladder tumours[21] and bladder outlet obstruction, such as prostate conditions.[22]
• Bladder-neck incision (BNI)
• Removal of the prostate - open, robotic, and endoscopic techniques are used.
• Stenting of the prostate[23] and urethra.
• Transurethral resection of the prostate (TURP)
• Transurethral microwave thermotherapy
• Urethral dilatation, a common treatment for strictures.