Patients with LUTS most commonly present to a primary care provider, mid-level Advanced Practice Provider (APP), or a urologist. However, given the complex regulation of lower urinary tract function by multiple organ systems, it is highly likely for other subspecialists (e.g., neurologists, nephrologists, cardiologists, sleep specialists, etc.) to encounter men reporting these symptoms as well. A complete medical history should be taken to assess urinary symptoms, prior genitourinary procedures or trauma, possible causes of neurogenic LUTS, sexual history, bowel habits, comorbidities, use of medications, cognitive functioning, fluid consumption habits/behavior, and general mental and physical health. The presence or history of these absolute indications for BPH treatment (if attributed to BPH) should also be assessed: bladder stones, upper urinary tract deterioration (obstructive uropathy), recurrent or significant gross hematuria, rUTIs, AUR in the absence of an alternative etiology (e.g., anesthesia, adverse drug effect, UTI), and recurrent AUR requiring catheterization. As highlighted in prior Guidelines on this topic, LUTS are non-specific and multifactorial. LUTS/BPH and subsequent BOO is just one of many different male LUTS etiologies. This is perhaps most strongly demonstrated by the parallel rise in LUTS including overactive bladder (OAB) with increasing age among both women and men due to a combination of both shared and sex-specific pathophysiology.24-26 The importance of considering non-obstructive LUTS etiologies is further supported by the low specificity of severe LUTS for BOO based on gold-standard UDS.27 Therefore, clinicians should screen for common non-BPH causes of LUTS such as neurogenic LUTS, infections, and complications of a prior genitourinary or pelvic procedure, trauma, or iatrogenic injury such as urethral stricture. Given the contribution of certain sexually transmitted diseases (e.g., gonorrhea, chlamydia) to urethral strictures and the frequent co-occurrence of LUTS and ED, a detailed sexual history should be obtained.28, 29 Relevant comorbidities include volume overload states (e.g., heart failure, advanced kidney disease, and liver disease), diabetes, hyperthyroidism, constipation, back pain or radiculopathy, and polydipsia/polyuria.30-35 Given the high prevalence and potential contribution of metabolic syndrome to BPH development and progression, clinicians should also screen for cardiometabolic risk factors, including obesity, hyperglycemia, hypertension, and hyperlipidemia.36 Similarly, obstructive sleep apnea (OSA), primary sleep disorders (e.g., restless legs, insomnia), cardiovascular disease, and lower extremity edema may contribute to nocturia.37-40 Recent anesthesia and prescribed or recreational drugs that are sedating (e.g., opioids), decrease detrusor contractility (e.g., anticholinergics, antihistamines, tricyclic antidepressants, calcium channel blockers), or increase outlet resistance (e.g., stimulants, chronic decongestant use, imipramine, duloxetine) are particularly important to capture for men with predominant voiding LUTS. Conversely, storage LUTS may be caused by diuretics, selective serotonin reuptake inhibitors (SSRIs), cholinesterase inhibitors, or sodium-glucose cotransporter-2 (SGLT2) inhibitors. Initial use of SGLT2 inhibitors for diabetes may increase frequency due to glycosuria. Since LUTS are associated with poor mental and physical health and several BPH treatments have cognitive or mental health side effects, these should be assessed at baseline to monitor for changes with treatment.41-49 Lastly, health-related behaviors, including smoking, sedentary lifestyle, alcohol and caffeine intake, poor diet quality, substance abuse, and fluid consumption habits should also be assessed. Ketamine-induced bladder toxicity is increasingly recognized.50 A comprehensive physical exam should be conducted during the initial evaluation for BPH, including lower abdominal palpation, assessing the urethral meatus and phallus for any signs of fibrosis/stricture, a rectal exam and digital rectal examination (DRE) to assess pelvic floor tone and pain, a gross estimate of prostate volume, and stool burden. Depending on the history, clinicians should assess for signs of non-BPH causes of LUTS with additional physical exam maneuvers, such as neurologic function and volume status. In men who are not catheter-dependent, the IPSS or another validated self-administered LUTS questionnaire provides clinicians with information regarding symptom burden and provides a means for assessing symptom improvement or deterioration in follow-up. If the IPSS is being used, then urinary incontinence, post-void dribbling, and pain should be assessed separately. The IPSS also has storage and voiding subscores which can be calculated separately. Patients should be asked which urinary symptom(s) is the most bothersome to ensure that therapeutic options include those that are most likely to address what is motivating them to seek treatment. If patients are reporting predominantly storage LUTS or isolated nocturia, then a frequency-volume chart can provide additional information regarding etiology, and clinicians should consult the AUA/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder.51, 52 Additionally, a urinalysis can help clinicians to rule out non-BPH causes of LUTS. When interpreting the results of the urinalysis, clinicians should consider whether the patients have typical UTI symptoms (e.g., acute-onset dysuria and frequency) and confirm the presence of bacteria with a reflex urinary culture prior to treating with antibiotics; bacteriuria alone should not be treated in the absence of UTI symptoms. Glucosuria should prompt an evaluation for diabetes. Microscopic hematuria in the absence of an infection should be evaluated according to the AUA/SUFU Microhematuria Guideline.53 Proteinuria, specific gravity, dysmorphic red blood cells, or certain casts should prompt an evaluation for kidney disease and consider a referral to nephrology. Low specific gravity may be a sign of polydipsia/polyuria.