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Lower Urinary Tract Symptoms in Men

NICE Clinical guideline [CG97] Lower urinary tract symptoms in men: management. Last updated: Jun 2015. TO BE REVIEWED!

Guidelines

Only consider pharmacological management if conservative measures failed.

Control fluid intake + avoid bladder irritants

Bladder training - for overactive bladder
Pelvic floor muscle training (at least 3 months) - for stress incontiennce

1st line: anti-cholinergic (e.g. oxybutynin, tolterodine, darifenacin)
2nd line: beta-3 receptor agonist (e.g. mirabegron, vibegron)

Common reasons to avoid anti-muscarinics are:

Glaucoma
Patient of old age / at risk of cognitive impairment / with cognitive impairment
Known myasthenia gravis

Control fluid intake + avoid bladder irritants
Urethral milking - for post-micturition dribbling

Moderate / severe symptoms → alpha blocker (e.g. doxazosin, tamsulosin) (for immediate symptomatic relief)
Enlarged prostate (>30 g) + consider at high risk of progression → 5-alpha reductase inhibitor (e.g. finasteride)

If both the above are present → offer both

References

NICE Lower urinary tract symptoms in men: management

Author: Adams Lau
Reviewer:
Last edited: 25/04/25

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