NICE has published a clinical guideline (CG97) on the effective management of lower urinary tract symptoms (LUTS) in men.

In terms of drug treatment, NICE make the following recommendations:

• Offer drug treatment only to men with bothersome LUTS when conservative management options have been unsuccessful or are not appropriate.

• Take into account comorbidities and current treatment when offering drug treatment for LUTS.

• Offer an alpha blocker (alfuzosin, doxazosin, tamsulosin or terazosin) to men with moderate to severe LUTS.

• Offer an anticholinergic to men to manage the symptoms of overactive bladder.

• Offer a 5-alpha reductase inhibitor to men with LUTS who have prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml, and who are considered to be at high risk of progression (for example, older men).

• Consider offering a combination of an alpha blocker and a 5-alpha reductase inhibitor to men with bothersome moderate to severe LUTS and prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml.

• Consider offering an anticholinergic as well as an alpha blocker to men who still have storage symptoms after treatment with an alpha blocker alone.

• Consider offering a late afternoon loop diuretic for nocturnal polyuria.

• Consider offering oral desmopressin4 for nocturnal polyuria if other medical causes have been excluded and the man has not benefited from other treatments. Measure serum sodium 3 days after the first dose. If serum sodium is reduced to below the normal range, stop desmopressin treatment.

• If LUTS do not respond to drug treatment, discuss active surveillance (reassurance and lifestyle advice without immediate treatment and with regular follow-up) or active intervention (conservative management or surgery).

• Do not offer homeopathy, phytotherapy or acupuncture.

Please see full guideline for further details.