Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- sintomas de armazenamento
- sintomas de micção
Other diagnostic factors
- febre com disúria
- retenção urinária
Risk factors
- idade superior a 50 anos
- história familiar de HPB
- raça não asiática
- tabagismo
- alopécia androgênica
- síndrome metabólica
Diagnostic investigations
1st investigations to order
- urinálise
- antígeno prostático específico (PSA)
- questionário de escore de sintomas
- quadro de frequência/volume e diário de micção
Investigations to consider
- ultrassonografia
- TC ou RNM do abdome/pelve
- cistoscopia
- Avaliação do resíduo pós-miccional (RPM)
- urofluxometria
- estudos urodinâmicos de pressão de fluxo
- avaliação da função renal
Treatment algorithm
sintomas não incômodos
sintomas incômodos sem indicação de cirurgia
sintomas incômodos com indicação de cirurgia: volume da próstata ≤30 g
sintomas incômodos com indicação de cirurgia: volume da próstata 30-80 g
sintomas incômodos com indicação de cirurgia: volume da próstata ≤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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-9.Full text Abstract
European Association of Urology. Management of non-neurogenic male LUTS. 2024 [internet publication].Full text
Elterman D, Aubé-Peterkin M, Evans H, et al. Update - Canadian Urological Association guideline: male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J. 2022 Aug;16(8):245-56.Full text Abstract
Expert Panel on Urological Imaging; Alexander LF, Oto A, Allen BC, et al. ACR Appropriateness Criteria® lower urinary tract symptoms - suspicion of benign prostatic hyperplasia. J Am Coll Radiol. 2019 Nov;16(11s):S378-83.Full text Abstract
McConnell JD, Roehrborn CG, Bautista O, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003 Dec 18;349(25):2387-98. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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- Bexiga hiperativa
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Câncer de próstata
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