This chapter focuses on lower urinary tract dysfunction in middle-aged and older men.

Definition

The International Continence Society uses the term ‘lower urinary tract symptoms’ (LUTS) as an umbrella heading covering a range of urinary dysfunction as reported by the individual patient or their caregiver (Abrams et al., 2002). Under this general heading individual urinary symptoms are sub-divided into three symptom groups according to their functional characteristics: storage symptoms, voiding symptoms and post-micturition (i.e. post-urination) symptoms. Definitions of the principal symptoms in each of these sub-groups are presented in Table 1.

Prevalence

LUTS has become increasingly common with age. Evidence from community surveys shows that 20–30% of men over the age of 50 experience moderate to severe LUTS when assessed aggregately (e.g. in Germany, Berges et al., 2001). The prevalence of individual urinary symptoms ranges from 6% for straining to 49% for terminal dribbling, with 93% of men (≥55 years) reporting some degree of current urinary dysfunction (Wolfs et al., 1994). Extrapolated to the UK population these figures suggest there are between 1.8 and 2.7 million men (≥50 yrs) with a moderate to severe degree of (aggregated) urinary dysfunction and up to 8.3 million men (≥50 yrs) who currently experience at least one urinary symptom; albeit the majority of these symptoms will be mild.

Aetiology

The classification of LUTS into storage and voiding symptoms is a well established heuristic and has received both psychometric and, to a lesser extent, clinical support (Donovan et al., 2000).