 Initial assessment of LUTS includes obtaining relevant medical history, performing a focused physical examination, and assessing symptom severity by one of several validated questionnaires. The International Prostate Symptom Score (IPSS) is used most commonly in the United States, and other validated questionnaires include the International Consultation on Incontinence Questionnaire and the Danish Prostate Symptom Score. These scores identify dominant symptoms (storage or voiding) and can be used to monitor response to therapy. Voiding charts (eg, frequency-volume chart) can be created by the patient to actively record several days of voiding time and volume. A physical examination should include an abdominal examination for bladder distention, a detailed genitourinary examination for any stricturing disease or urethral mass, a digital rectal examination to assess prostate size, and a neurological examination of the perineum and lower limbs. Digital rectal examination can be inaccurate for volume estimation and cancer detection and is most useful for identifying an enlarged prostate with volume >50g [4]. Initial laboratory analysis may include prostate serum antigen level if desired, following appropriate shared decision-making discussion. Urinalysis can be obtained to evaluate for urinary tract infection, glucosuria and proteinuria as cause of urinary frequency, and microhematuria. Urinalysis results may lead to an additional workup beyond the scope of this topic [1,2,5]. Pressure flow urodynamics is considered the reference standard for determining the underlying cause of LUTS and differentiating between storage and voiding abnormalities. Watchful waiting with lifestyle modifications is appropriate for patients without bothersome symptoms. For patients with moderate to severe symptoms, medical therapy with 1-adrenoceptor antagonists is a first-line therapy.
Lower Urinary Tract Symptoms Suspicion of Benign Prostatic Hyperplasia.  Initial assessment of LUTS includes obtaining relevant medical history, performing a focused physical examination, and assessing symptom severity by one of several validated questionnaires. The International Prostate Symptom Score (IPSS) is used most commonly in the United States, and other validated questionnaires include the International Consultation on Incontinence Questionnaire and the Danish Prostate Symptom Score. These scores identify dominant symptoms (storage or voiding) and can be used to monitor response to therapy. Voiding charts (eg, frequency-volume chart) can be created by the patient to actively record several days of voiding time and volume. A physical examination should include an abdominal examination for bladder distention, a detailed genitourinary examination for any stricturing disease or urethral mass, a digital rectal examination to assess prostate size, and a neurological examination of the perineum and lower limbs. Digital rectal examination can be inaccurate for volume estimation and cancer detection and is most useful for identifying an enlarged prostate with volume >50g [4]. Initial laboratory analysis may include prostate serum antigen level if desired, following appropriate shared decision-making discussion. Urinalysis can be obtained to evaluate for urinary tract infection, glucosuria and proteinuria as cause of urinary frequency, and microhematuria. Urinalysis results may lead to an additional workup beyond the scope of this topic [1,2,5]. Pressure flow urodynamics is considered the reference standard for determining the underlying cause of LUTS and differentiating between storage and voiding abnormalities. Watchful waiting with lifestyle modifications is appropriate for patients without bothersome symptoms. For patients with moderate to severe symptoms, medical therapy with 1-adrenoceptor antagonists is a first-line therapy.