Perhaps the most common presentation to a urology clinic is the male patient with lower urinary tract symptoms (LUTS). Patients may present to a general urology clinic, via a ‘raised prostate specific antigen (PSA) clinic’ or as a result of a failed trial without catheter (TWOC). Many urology units are now striving to offer a merged ‘one‐stop’ clinic for all such conditions, and LUTS is a condition that lends itself well to the ethos of ambulatory care. In a well‐organised service, it should be possible to offer all necessary investigations and assessments in order to reach a diagnosis and plan treatment for the male LUTS patient.

Lower urinary tract symptoms may be divided into storage and voiding symptoms. This differentiation is made on patient history and dictates appropriate investigation. In patients with solely storage symptoms (urgency of urination, frequency, and nocturia), diagnoses such as infection, overactive bladder (OAB) syndrome, or detrusor overactivity (DO) should be considered. Patients with voiding symptoms (hesitancy, poor flow, intermittency, double voiding) and those with mixed voiding and storage symptoms are more likely to have bladder outflow obstruction as the underlying cause.

Bladder outflow obstruction must be considered in men presenting with urinary tract infection, orchitis, acute urinary retention, bladder stones, and also those with high post‐void residual volumes in the bladder and indications of chronic urinary retention.

Bladder outflow obstruction is, to a degree, considered synonymous with benign prostatic obstruction (BPO) and benign prostatic hyperplasia (BPH). Indeed, 50% of men have BPH by the age of 60. However, other causes of obstruction are not infrequent and should be excluded. Other diagnoses to consider should include urethral stricture disease, bladder neck stenosis, detrusor failure, and obstruction due to prostate cancer or urothelial cancer.