Lower Urinary Tract Dysfunction
Male LUTS: keep on learning

Patrick (71 years old)

Patrick, a 71-year-old married man, presents with increasing daytime frequency, nocturia, post-micturition dribbling and a poor urinary stream. These symptoms worsened during the last 1 year. He has no urinary incontinence.


Medical history: Loss of erectile function since worsening of LUTS. Hypertension (controlled with valsartan). BMI 26.
Physical examination: DRE: slightly enlarged but soft prostate. Prostate volume: 35 ml. No palpable bladder. Blood pressure, cardiac and lung auscultation: normal. No oedema. External genitals: normal.
IPSS: 18 (IPSS QoL: 3).
IIEF: 12/30.
Urinalysis: Normal.
Lab: Lipid profile, glucose, creatinine, testosterone: normal. PSA: 1.3 ng/ml.
Uroflowmetry: Qmax: 10 ml/s. PVR: 15 ml. Voided volume: 225 ml.
Bladder diary: Frequency: day 9x, night 2x. Nocturnal diuresis: 20% of 24-hour volume. Variable urine volume. Normal fluid intake.

Which treatment is the most appropriate to improve his symptoms?