How to cite: Sur RL. Workup of the Male patient with LUTS. Grand Rounds in Urology. March 2026. Accessed Oct 2026. https://grandroundsinurology.com/workup-of-the-male-patient-with-luts/
Summary
Roger L. Sur, MD, Professor, Department of Urology, University of California, San Diego, San Diego, California, reviews the clinical workup of male patients presenting with lower urinary tract symptoms, emphasizing the importance of distinguishing between obstructive and storage symptoms to guide management.
Obstructive symptoms include hesitancy, weak urinary stream, incomplete emptying, and prior episodes of acute urinary retention, suggesting bladder outlet obstruction. In contrast, storage symptoms include urinary frequency, urgency, nocturia, and urge incontinence, reflecting overactive bladder physiology. Patients often present with a combination of both symptom types, making careful history essential.
Dr. Sur highlights key elements of the clinical history, including episodes of gross hematuria, urinary tract infections, and a family history of prostate cancer. A single episode of gross hematuria warrants referral to urology due to the risk of underlying malignancy. Medication review is critical, as diuretics and decongestants may exacerbate symptoms or precipitate urinary retention. Behavioral factors such as fluid intake, caffeine intake, alcohol intake, diet, and constipation should also be assessed. A voiding diary may provide valuable insight into fluid intake and urinary patterns.
The physical examination is limited but focused, including assessment of external genitalia, abdominal palpation for urinary retention, and digital rectal examination when clinically indicated. Dr. Sur emphasizes that digital rectal examination should not be used as a screening test for prostate cancer due to low predictive value, but may be useful diagnostically in symptomatic patients.
Initial laboratory evaluation includes urinalysis to assess for infection, hematuria, proteinuria, or glucosuria. Prostate-specific antigen testing is recommended for prostate cancer screening, beginning at age 45 to 50, or earlier in high-risk individuals.
Dr. Sur emphasizes that a structured, history-driven approach, combined with selective testing, enables efficient and effective evaluation of male patients with lower urinary tract symptoms.
About the UCSD Urology Symposium for Primary Care Physicians & Advanced Practice Providers
The UCSD (University of California San Diego) Urology Symposium for Primary Care Physicians & Advanced Practice Providers conference brings together primary care physicians, advanced practice providers, and early-career urology clinicians who play pivotal roles in the urologic care continuum. It features topics such as benign prostatic hyperplasia, overactive bladder, kidney stones, sexual health, and urologic oncology. Through didactic lectures and interactive sessions that highlight the patient journey, the conference educates practitioners on guiding patients and their families toward the most appropriate therapies.
ABOUT THE AUTHOR
Roger L. Sur, MD, is the Founder and Director of the Comprehensive Kidney Stone Center, a Professor in the Department of Urology, and the Director of the joint UC San Diego-Kaiser Endourology Fellowship at the University of California, San Diego. Dr. Sur also holds positions as a Urologist at the VA San Diego Healthcare System and as an Associate Professor of Surgery at the Uniformed Services University. He specializes in percutaneous nephrolithotomy using the latest, minimally invasive techniques.
