Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Personalized care for male LUTS: have we attained the holy grail?

Personalized decision-making is the ultimate goal of managing men with lower urinary tract symptoms caused by benign prostatic obstruction. Urodynamics can provide valuable information in these patients and a recent multicentre randomized trial has highlighted important findings warranting consideration, as well as indicating that further insights are needed.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Coyne, K. S. et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 103 (Suppl. 3), 4–11 (2009).

    Article  PubMed  Google Scholar 

  2. Gravas, S. et al. Management of non-neurogenic male LUTS. EAU (2020).

  3. Jeong, S. J. et al. Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J. Urol. 53, 342–348 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Neal, D. E. et al. Outcome of elective prostatectomy. BMJ 299, 762–767 (1989).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Thomas, A. W., Cannon, A., Bartlett, E., Ellis-Jones, J. & Abrams, P. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int. 93, 745–750 (2004).

    Article  CAS  PubMed  Google Scholar 

  6. Drake, M. J. et al. Diagnostic assessment of lower urinary tract symptoms in men considering prostate surgery: a noninferiority randomised controlled trial of urodynamics in 26 hospitals. Eur. Urol. (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Strand, D. W., Costa, D. N., Francis, F., Ricke, W. A. & Roehrborn, C. G. Targeting phenotypic heterogeneity in benign prostatic hyperplasia. Differentiation 96, 49–61 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Selman, L. E., Ochieng, C. A., Lewis, A. L., Drake, M. J. & Horwood, J. Recommendations for conducting invasive urodynamics for men with lower urinary tract symptoms: qualitative interview findings from a large randomized controlled trial (UPSTREAM). Neurourol. Urodyn. 38, 320–329 (2019).

    Article  PubMed  Google Scholar 

  9. Lewis, A. L. et al. Clinical and patient-reported outcome measures in men referred for consideration of surgery to treat lower urinary tract symptoms: baseline results and diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). Eur. Urol. Focus 5, 340–350 (2019).

    Article  PubMed  Google Scholar 

  10. Aiello, M. et al. Quality control of uroflowmetry and urodynamic data from two large multicenter studies of male lower urinary tract symptoms. Neurourol. Urodyn. 39, 1170–1177 (2020).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sachin Malde.

Ethics declarations

Competing interests

E.S. has received consultancy fees from Laborie. S.M. declares no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Malde, S., Solomon, E. Personalized care for male LUTS: have we attained the holy grail?. Nat Rev Urol 17, 607–608 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI:


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing