Lower Urinary Tract Dysfunction
Male LUTS: keep on learning

Marco (63 years old)

Marco, a 63-year-old web developer, complains of a moderate stream, sometimes the need to strain while voiding and increased voiding frequency, both during day and night. Occasionally he experiences little urge incontinence when voiding is delayed. The most bothersome symptom is nocturia. He already received an α-blocker without sufficient symptom improvement.


Medical history: Overweight (BMI 30). Erectile function satisfactory.
Physical examination: DRE: slightly enlarged but soft prostate. No palpable bladder. Blood pressure, heart and lung auscultation: normal. No signs of peripheral oedema.
IPSS: 24 (IPSS QoL: 4).
Urinalysis: Normal.
Lab: PSA: 1.2 ng/ml. Renal function and HbA1c: normal.
Uroflowmetry: Qmax: 12 ml/s. Voided volume: 180 ml. No PVR.
Bladder diary: Frequency: day 9x, night 3x. Variable urine volume. Moderate urgency. Nocturnal diuresis: 34% of 24h volume. Normal amount of fluid intake, including 2 cups of coffee.

Which treatment is the most appropriate to treat his most bothersome complaint?