Approach to the male patient with lower urinary tract dysfunction.

History and physical examination are the cornerstones of evaluation of the male patient with lower urinary tract (LUT) symptoms and (suspected) neurologic disorder, both to diagnose the nervous system lesion, and to get insight into the type of LUT dysfunction (LUTD). Non-neurologic LUTD needs to be ruled out. Laboratory testing is necessary to diagnose urinary infection. In those in whom neurogenic LUTD is probable, postvoid residual urine and urinary flow measurement generally rule out significant outflow obstruction and allow for basic symptomatic management. If symptomatology is complex or severe, or the pathophysiology uncertain, or invasive treatment planned, urodynamic or videourodynamic measurements should be performed to inform on bladder sensation, detrusor contractility, pressures generated in the bladder, as well as the behavior of bladder neck, the striated urethral sphincter, and urinary flow. This information is paramount to the clinician to plan management and consider prognosis. Assessment needs to be repeated, as chronic neurogenic LUTD is not a stable condition; in progressive neurologic diseases the nature of LUTD itself may change. The upper urinary tract needs to be checked and followed up regularly, particularly in patient groups in which high intravesical pressures may be generated.