A 68-year-old man presents to the clinic with a 6-month history of worsening urinary symptoms. He reports a sensation of incomplete bladder emptying and a urinary stream that is “weak and intermittent.” He has to strain to initiate voiding and reports significant nocturia, waking up 3 to 4 times per night to urinate. He denies dysuria, hematuria, or flank pain. He has no history of urinary tract infections or urethral strictures. His past medical history includes hypertension, for which he takes amlodipine. He does not smoke and drinks alcohol occasionally. His International Prostate Symptom Score (IPSS) is 22, indicating severe symptoms.

He is afebrile. His blood pressure is 134/82 mmHg with a pulse of 72 bpm and a respiratory rate of 14/min.