Lower Urinary Tract Dysfunction

Topic: Male LUTS: keep on learning

Case 1: Steve (67 years old)

Steve, a 67-year-old retired fireman, has a history of LUTS, particularly urgency and weak stream. The symptoms are bothersome and have worsened over the last 3 years.
 
Medical history: Coronary artery disease (aspirin). Hypertension (beta-blocker).
Physical examination: DRE: no abnormalities. Prostate volume: 50 ml.
IPSS: 20 (IPSS QoL: 4).
Urinalysis: Normal.
Lab: PSA: 1.9 ng/ml. Renal function: normal.
Bladder diary: Frequency: day 10x, night 1x. Voided volumes: 50-475 ml. Urgency.
Bladder scan: PVR: 70 ml.
Flowmetry: Qmax: 11 ml/s. Voided volume: 360 ml.

Which treatment is the most appropriate to treat his LUTS?