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Current advances in male lower urinary tract symptoms assessment and management: more and more questions.

DOI:10.1097/MOU.0000000000000250 millions of people worldwide and represent an important part of daily practice [1]. As a benign condition, male LUTS belong to the field of ‘functional urology’ and perfectly represent the challenges often faced in this field by urologists. Indeed, LUTSs are a chronic condition (thus, including the spectrum of ageing of the urinary tract), impact quality of life, have a complex pathophysiology (sometimes linked to extraurological diseases) and require an extremely rigorous assessment of symptoms, clinical context and patient expectations. Once the origin of LUTSs has been stated [being often, but not always, benign prostatic obstruction (BPO)], therapeutic options are multiple, involving a broadening list of available medications and a widening range of surgical options. Since the mid-1990s, and until recently, all these aspects of male LUTS assessment and management have dramatically evolved, leading to multiple ‘paradigm shifts’ [2–5]. However, several practical issues remain unsolved, and additional efforts are warranted to translate these inputs in daily clinical practice. The first area where new key concepts have been introduced is male LUTS pathophysiology. Nearly 20 years after the introduction of the concept of LUTS [6], a distinction has been made between benign prostatic hyperplasia (a ‘disease’), benign prostatic enlargement (an ‘anatomical modification’) and BPO (a ‘phenomenon’). It has been further stated in landmark articles that LUTS origins may involve the prostate, but also bladder dysfunction, and other causes such as neurological diseases [5]. This statement is relevant for all types of LUTS: ‘voiding symptoms’ (which can be related to not only bladder outlet obstruction, but also detrusor overactivity or hidden neurological dysfunction), ‘storage symptoms’ and particularly overactive bladder (OAB) symptoms (which can be due to specific bladder dysfunction), and nocturia that has multiple associated origins [7]. In this issue of Current Opinion in Urology, Rademakers et al. (pp. 3–10) make a standpoint