Modern evaluation of lower urinary tract symptoms in 2014

To evaluate and present the evidence for the use of different investigation modalities in men with benign prostatic hyperplasia/lower urinary tract symptoms (LUTS) in 2014.

Cystometry remains the gold standard in differentiating obstructed from nonobstructed men with LUTS. Prostatic ultrasound measures such as the intravesical prostatic protrusion may be useful in counselling men before a trail without catheter or commencing α antagonists. Using a higher cut-off, the bladder thickness/weight measurement has a higher sensitivity but lower specificity and may allow men with obstruction to be excluded from requiring cystometry. These and other techniques such as near-infrared spectroscopy, penile cuff compression and computational flow modelling have shown good correlation with cystometry but still require more data, technical refinement and standardization, before they can be considered to be appropriate in routine clinical practice.

The last few years have seen an increase in the data regarding less invasive methods of cystometry. Although these do not provide the same information as cystometry, they may have a role in answering specific questions and counselling men with benign prostatic hyperplasia/LUTS. The key to incorporating these techniques in the assessment of men will lie with standardization and use for specific indications.