Benign prostatic hyperplasia (BPH) is one of the most common diseases to affect older men.Histological (microscopic) BPH, which is characterised by both stromal and glandular hyperplasia, is present in more than 60% of men beyond their sixties. More than 40% of men in this age group have lower urinary tract symptoms (LUTS) and about half this group have impaired quality of life. The prevalence increases with age, and the overall number of patients affected is rising worldwide as populations age. At current intervention rates, about one-fifth of patients with symptomatic disease who present to a doctor will eventually be treated surgically, although this may be falling. The remainder will often be managed initially by watchful waiting. However, the majority of these individuals suffer gradual progression of symptoms and the bother associated with them, and increasingly require treatment either with medication or surgery.

Acute urinary retention (AUR) is a common urological emergency. AUR is more than ten times more common in men than women. AUR in men tends to occur in the elderly and the risk of AUR is higher in men > 70 years. Those in this age group have a 10% risk of developing AUR over a five-year period. The incidence of AUR is low in the general male population of 45 years or older.  However, in almost 50% of AUR patients with benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), AUR was their first symptom. GPs can play a major role in identifying patients who need assessment for BPH/LUTS and starting early treatment with pharmacotherapy. Health education should address the importance of compliance with medication and patients should be followed up to reduce the risk of AUR and surgical intervention. Urological intervention may only be required in cases where specialised assessment or treatment is needed and in patients where catheter insertion has failed during an episode of AUR.

GPs are increasingly becoming involved in the care of patients with prostate cancer. Men dying from advanced disease often suffer intractable bone pain and debilitating lower urinary tract symptoms which have a considerable impact on their quality of life. In the absence of a breakthrough in the treatment of metastatic disease, earlier diagnosis and more effective eradication of clinically significant disease currently seem to afford the best opportunity of stemming the tide.

Urology practice includes large numbers of ageing men presenting with urinary symptoms, haematuria, urogenital cancer and sexual dysfunction. As with women, hormonal changes in men may be associated with significant health-related problems. Often symptoms are misleading in older patients and may be related to different pathology.

Prostate cancer is the most common cancer in men. More than 35,000 new cases are diagnosed annually and almost 10,000 men die each year in the UK from this disease.  Now an increasing majority of patients present with an isolated increase in prostate specific antigen (PSA). In the USA, where PSA testing is widely adopted, the death rate from prostate cancer is falling four times faster than in the UK.

Finding an unusual lump in the scrotum or testicle can be very distressing for patients. Although less than 5% of testicular lumps are cancerous a systematic approach needs to be undertaken in all cases to rule out malignancy. Testicular lumps require careful clinical assessment and may need further investigations such as ultrasound.

Benign prostatic hyperplasia (BPH) is the most common condition to affect older men. Almost half of all men older than 65 years have lower urinary tract symptoms (LUTS), consisting of poor flow and frequency of micturition, which may have a severely negative impact on quality of life. As BPH is generally a disorder of older men, it is frequently associated with comorbid conditions such as erectile dysfunction, hypertension and prostate cancer. These need to be identified and taken into account at the time of diagnosis, as their presence may impact on treatment strategies.The main risk factors for BPH are age, family history and possibly obesity.

Erectile dysfunction (ED) is a common condition defined by the inability to achieve and sustain an erection adequate for sexual intercourse. Population studies estimate a prevalence of between 32% and 52% for all grades of ED.^1,2 ED is more common as age increases, and one study found the prevalence of complete ED to triple, from 5% to 15%, between the ages of 40 and 70.² there is increasing evidence to support a vascular aetiology. ED and cardiovascular disease (CVD) share common risk factors. So modifying risk factors for CVD may lead to an improvement in erectile function. Early identification of ED may also provide a window of opportunity in which clinicians can take preventative measures against the development of CVD. There is increasing evidence to support a vascular aetiology. ED and cardiovascular disease (CVD) share common risk factors. So modifying risk factors for CVD may lead to an improvement in erectile function. Early identification of ED may also provide a window of opportunity in which clinicians can take preventative measures against the development of CVD.

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