Lower urinary tract symptoms—including voiding, storage, and postvoiding symptoms—occur in half of men over 65 and adversely affect quality of life and activities of daily living.1 2 Treatment varies from watchful waiting (active surveillance and monitoring) to medical and surgical management. While absolute indications for surgery exist—including persistent retention, severe symptoms, and secondary renal impairment—recent experience in clinical practice suggests that most patients do not need surgery in the long term and can be managed by conservative measures.3 In this week's BMJ, Brown and colleagues report the first randomised controlled trial on the effect of self management training as a first line treatment in men with lower urinary tract symptoms.4

Symptoms associated with bladder outlet obstruction due to histological benign prostatic hyperplasia vary in nature and severity. Currently, …