Lower urinary tract symptoms, or LUTS, are the group of symptoms men notice as they get older: a weak or slow flow, getting up at night, needing to go urgently, dribbling, or a feeling the bladder has not emptied. They are most often caused by a benign enlarged prostate and can be improved with medication or a range of minimally invasive procedures.
Getting up twice a night, standing at a urinal waiting for something to happen, planning a journey around toilets: most men treat these as part of getting older and say nothing. They are called lower urinary tract symptoms, or LUTS, and they are among the most treatable problems in urology. Mr Vinod Nargund assesses the cause, rules out the serious ones, and offers the full range of treatments from tablets to modern minimally invasive procedures.
What are lower urinary tract symptoms?
Urologists split LUTS into two groups. Voiding symptoms are about getting the urine out: a weak or intermittent stream, hesitancy, straining, dribbling at the end, and a feeling of incomplete emptying. Storage symptoms are about holding it: needing to go often, needing to go urgently, leaking, and getting up at night. Most men have some of each, and the balance points towards the cause.
What causes them?
The most common cause is benign prostatic enlargement, where the prostate grows with age and squeezes the tube that drains the bladder. Other causes include an overactive bladder, a narrowing of the urethra, urine infection, prostatitis, bladder stones, diabetes and some medications. Prostate cancer rarely causes urinary symptoms in its early stages, but the assessment checks for it.
How are LUTS assessed?
- A symptom score and a bladder diary, which show the pattern and how much it affects you.
- Examination, including of the prostate.
- Urine tests, and a PSA blood test where appropriate.
- A flow test, which measures the speed of your stream, and a bladder scan to see how much is left afterwards.
- Ultrasound or a flexible cystoscopy in selected cases.
What are the treatment options?
- Lifestyle changes, such as adjusting evening fluids, caffeine and alcohol, and bladder training, which help more than most men expect.
- Medication. Alpha blockers relax the prostate and improve flow within days. Other tablets shrink the prostate over months, or calm an overactive bladder.
- Minimally invasive procedures for men who want to avoid long-term tablets or have not responded to them, such as UroLift, Rezum and similar techniques, most done as day cases.
- Surgery to remove the obstructing part of the prostate, including TURP and laser procedures, for larger prostates or when the bladder is struggling.
When should you see a specialist?
If your symptoms are affecting your sleep, your work or your confidence, if you have any blood in your urine, if you have had an infection, or if you find you suddenly cannot pass urine at all, which is an emergency. There is no need to wait until it is unbearable.
Sources
NICE guideline CG97 on lower urinary tract symptoms in men, the British Association of Urological Surgeons patient information, and NHS guidance on benign prostate enlargement.
Reviewed by Mr Vinod Nargund, MBBS, PhD, FRCS(Urol), FEBU. Last updated 12 September 2026.