Storage LUTS in men are often left untreated,199 even though these symptoms can be highly bothersome, more so than voiding LUTS.200 In the EPIC study, of all men identified with LUTS, >80% had storage LUTS.201 In the EpiLUTS study,202 storage symptoms were experienced by around two-thirds of men, with approximately 50% of men reporting mixed storage and voiding symptoms. In patients with a prostate who present with OAB, predominant LUTS should be evaluated to assess for the relative contribution of BOO secondary to BPH. Clinicians should follow the clinical workflow outlined earlier in this Guideline, which considers assessing the presence and severity of urinary symptoms using standardized questionnaires, PVR, prostate volume determination, and measurement of flow rate. Those who are found to have voiding symptoms (e.g., weak stream, difficulty initiating a stream, intermittency) should follow the algorithms to manage the outlet. In studies for anticholinergics with ABs or an AB alone, there is evidence to support symptomatic, quality of life improvement with combination therapy with low risk of retention. Two meta-analyses and four RCTs have evaluated cohorts of patients with storage LUTS and concomitant BPH. The studies compared combination therapy with ABs and either antimuscarinic medications or beta-3 agonists to monotherapy with an alpha-adrenergic antagonist.203, 204 Combined use of tamsulosin and solifenacin showed significant improvement in storage symptoms compared to tamsulosin monotherapy. The AUA/SUFU OAB Guideline further addresses the use of anticholinergics in men with storage symptoms.52 At three to six months follow-up, treatment with an AB plus tolterodine versus placebo was associated with improved total IPSS and quality of life score in two trials, though the smaller trial showed a larger benefit.141, 144 The larger trial (n=447) showed a large increase in withdrawal due to adverse event (WAE) associated with combination therapy;141 the smaller trial (n=76) found a large increase in rates of dry mouth, but WAE rates were low in both treatment groups.144 Three RCTs of solifenacin plus an AB (n=1,023) showed a decrease in total IPSS associated with combination therapy versus placebo that was statistically significant but may not have been clinically significant (weighted mean difference [WMD]: -1.50 points; 95% CI: -1.80 to -1.20). The IPSS quality of life scores also improved (1 RCT; n=629). The three trials suggested a large increase in WAE associated with treatment, but the estimate was imprecise.141