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Lower urinary tract symptoms in men, age-related (including symptoms of benign prostatic hyperplasia/hypertrophy) - Management
Basis for recommendation

These recommendations are in line with the guideline The management of lower urinary tract symptoms in men from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2010] and are based on expert opinion [Reynard et al, 2006; NICE, 2010].

Usefulness of urine dipstick tests for excluding bladder cancer, urinary tract infection, and urinary calculi in men with lower urinary tract symptoms (LUTS)

  • The NICE systematic review found only one study that assessed the usefulness of urine dipstick tests for excluding bladder cancer, urinary tract infection, and urinary calculi in men with LUTS suggestive of benign prostatic hyperplasia (BPH). The study had serious methodological limitations that make the data unreliable.
  • NICE found no trials for urine dipstick tests to exclude diabetes and renal disease in men with LUTS suggestive of BPH.

Serum creatinine to assess renal function

  • NICE recommends offering men with LUTS a serum creatinine test to assess for renal impairment only when there are clinical indications of causes of renal impairment. NICE noted that most laboratories now report eGFR (estimated glomerular filtration rate) alongside blood creatinine levels.
  • NICE found no trials that assessed clinical outcomes in men who had renal function measured.

PSA test to predict progression of symptoms and clinical outcomes

  • The NICE systematic review found no directly relevant studies on the effect of strategies of PSA testing on eventual clinical outcomes.
  • The NICE systematic review found six studies that assessed how accurately the PSA test predicts progression of symptoms. The results were inconsistent, and no reliable conclusion could be drawn.

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