Male LUTS

GGC - Primary Care
NHS GGC

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GGC Medicines: Drugs for genito-urinary disorders

Patient presenting symptom details

  • Storage – urgency, frequency, nocturia
  • Voiding – slow stream, straining, hesitancy, terminal dribbling1-3

Red flag symptoms present

Refer to Urology as USOC, HighPSA pathway

 

  • Recurrent MSSU positive UTIs1
  • Persistent bladder pain
  • Pelvic mass
  • Previous urological cancer
  • Penile lesion or painful phimosis

Refer as Urgent or USOC accordingly

Symptom assessment

  • Symptom assessment: IPSS2 (see link)
    +/- bladder diary
  • Examination:1 for palpable bladder, external genitalia and DRE
  • Urine: urinalysis +/- MSSU
  • Bloods: U&Es, PSA

Simple management advice

  • Adequate fluid intake (1.5–2 L)
  • Reduced caffeinated and carbonated drinks
  • Minimise fluid intake 2 hours before bed
  • Weight loss if BMI >30
  • Avoid constipation3

Not improving/no change/next steps

Predominantly voiding LUTS:

Predominantly storage LUTS (or no improvement with voiding LUTS treatment):

Criteria for secondary referral to Urology

  • Bothersome symptoms despite above measures
  • USOC or Urgent referral if red flag symptoms present

Patient information leaflet link

QR code

Lower urinary tract symptoms (LUTS) in men: information about your bladder condition from The British Association of Urological Surgeons (BAUS)

 

IPSS questionnaire

Abbreviations

  • BMI, body mass index
  • DRE, digital rectal examination
  • IPSS, International Prostate Symptom Score
  • LUTS, lower urinary tract symptoms
  • MSSU, midstream specimen of urine
  • OD, once daily
  • PSA, prostate-specific antigen
  • U&Es, urea and electrolytes
  • USOC, urgent suspicion of cancer
  • UTI, urinary tract infection

References

  1. NICE. Lower urinary tract symptoms in men: management. 2015. Available at: www.nice.org.uk/guidance/cg97 (Accessed: January 2025)
  2. NICE. LUTS in men. 2024. Available at: cks.nice.org.uk/topics/luts-in-men (Accessed: January 2025)
  3. British Association of Urological Surgeons (BAUS). LUTS in men. 2023. Available at: www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Male%20LUTS.pdf (Accessed: January 2025)

Editorial Information

Last reviewed: 12/08/2025

Next review date: 30/06/2026

Author(s): Consultant Urologist.

Version: 1

Approved By: Urology South and North Sector