Intended for healthcare professionals

Clinical Review State of the Art Review

Lower urinary tract symptoms in men

BMJ 2014; 349 doi: (Published 14 August 2014) Cite this as: BMJ 2014;349:g4474
  1. John M Hollingsworth, assistant professor of urology12,
  2. Timothy J Wilt, professor of medicine34
  1. 1Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
  2. 2Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI, USA
  3. 3Minneapolis VA Center for Chronic Diseases Outcomes Research, Minneapolis, MN 55417, USA
  4. 4University of Minnesota School of Medicine, Minneapolis, MN, USA
  1. Correspondence to: T J Wilt tim.wilt{at}


Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.


  • Contributors: Both authors conceived the idea; contributed intellectual content; acquired and analyzed evidence; and wrote, reviewed, and edited the manuscript.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: Funding from the Agency for Healthcare Research and Quality (1K08HS020927-01A1 to JMH).

  • Provenance and peer review: Commissioned; externally peer reviewed.

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