Summary
Definition
History and exam
Key diagnostic factors
- storage symptoms
- voiding symptoms
Other diagnostic factors
- fever with dysuria
- urinary retention
Risk factors
- age over 50 years
- family history of BPH
- non-Asian race
- cigarette smoking
- male pattern baldness
- metabolic syndrome
Diagnostic investigations
1st investigations to order
- urinalysis
- prostate-specific antigen (PSA)
- International Prostate Symptom Score
- volume charting
Investigations to consider
- ultrasound
- CT abdomen/pelvis
- MRI abdomen/pelvis
- cystoscopy
- uroflowmetry
- urodynamic study
- assessment of renal function
Treatment algorithm
non-bothersome symptoms
bothersome symptoms with no indications for surgery
bothersome symptoms with indication for surgery: prostate volume ≤30 g
bothersome symptoms with indication for surgery: prostate volume 30-80 g
bothersome symptoms with indication for surgery: prostate volume ≥80 g
Contributors
Authors
Claus Roehrborn, MD
Professor
Urology
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
CR is on an ad board for Teleflex; consults for Teleflex, Zenflow, and Medeon; and has done research with Zenflow and Teleflex. CR is an author of several references cited in this topic.
Ramy Goueli, MD
Assistant Professor
Urology
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
RG declares that he has no competing interests.
Acknowledgements
Professor Claus Roehrborn and Dr Ramy Goueli would like to gratefully acknowledge Professor Michael T. Flannery and Dr Erika Abel, the previous contributors to this topic. Regretfully, Professor Flannery died in December 2020.
Disclosures
EA declares that she has no competing interests.
Peer reviewers
Christopher R. Chapple, BSc, MD, FRCS (Urol), FEBU
Consultant Urological Surgeon
Royal Hallamshire Hospital
Honorary Senior Lecturer of Urology
University of Sheffield
Newcastle University
Visiting Professor of Urology
Sheffield Hallam University
Adjunct Secretary responsible for Education
European Association of Urology
Sheffield
UK
Disclosures
CRC is Chairman of NICE Male LUTS Guidelines Development Group.
Robert Pickard, MD, FRCS (Urol)
Professor of Urology
Institute of Cellular Medicine
Newcastle University
Newcastle upon Tyne
UK
Disclosures
RP has received funding from the UK NHS (NIHR) to undertake commissioned reviews of treatment for benign prostatic enlargement.
Steven K. Brooks, MD
Chief
Department of Surgery
South Seminole Hospital
Longwood
FL
Disclosures
SKB is a member of the National Speakers Bureau for Boehringer Ingelheim, Astellas Pharmaceuticals, and Glaxo Pharmaceuticals and has served as a consultant for these companies.
Differentials
- Overactive bladder
- Prostatitis
- Prostate cancer
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- Canadian Urological Association guideline update: male lower urinary tract symptoms/benign prostatic hyperplasia
- Management of non-neurogenic male LUTS
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