Effective management of male lower urinary tract symptoms in primary care

Lower urinary tract symptoms (LUTS) constitute a substantial burden on males due to their high prevalence (up to 30% of males aged >65 years)1 and significant impact on quality of life. Prevalence and severity of LUTS increase with age; therefore, the burden on the NHS and primary care (where most males with LUTS are managed) is expected to grow, alongside population ageing. Yet a comparatively small proportion of affected males seek advice or treatment for their symptoms; reported as between 19% and 24% in studies conducted in Europe and the US. There is a perception among males that LUTS is a normal sign of ageing, which may be related to a lack of knowledge of the condition and available treatments. Indeed, qualitative research reported in the current issue of the BJGP suggests that GPs find it difficult to decide on the mechanism of LUTS in males. Remarkably, the situation is also problematic after referral for urological management, where incomplete discussions and misperceptions of LUTS and its treatment have also been identified. Unfortunately, this can lead to a situation where treatment seems to be a case of 'trial and error'.