Materiały źródłowe

• #1 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and is a common cause of lower urinary tract symptoms (LUTS) in older men. Disease prevalence has been shown to increase with advancing age. The histological prevalence of BPH at autopsy is as high as 50% to 60% for males in their 60s, increasing to 80% to 90% of those older than 70 years of age. […] Several definitions exist in the literature when describing BPH. These include bladder outlet obstruction, LUTS, and benign prostatic enlargement (BPE). BPH describes the histological changes, BPE refers to the increased size of the gland (usually secondary to BPH), and bladder outlet obstruction is defined as the blockage to urinary flow. […] Lower urinary tract symptoms (LUTS) describe the urinary abnormalities shared by disorders affecting the bladder and prostate, typically caused by BPH.

• #2 Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment for Medicine

  https://www.picmonic.com/pathways/medicine/courses/standard/pathology-196/prostate-disorders-39447/benign-prostatic-hyperplasia-bph-diagnosis-and-treatment_1403

  Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment […] Accurately diagnosing BPH is extremely important as more serious conditions, such as prostate cancer must be ruled out. […] The examiner palpates the prostate to examine for nodules and asymmetry. The presence of these suggest prostate cancer and not BPH. […] Urinalysis is performed to rule out infection or presence of blood, which indicate other serious pathology that may require treatment. […] Men who develop serious complications, such as hydronephrosis or renal failure may require transurethral resection of the prostate (TURP), surgery to remove the prostate.

• #3 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and is a common cause of lower urinary tract symptoms (LUTS) in older men. Disease prevalence has been shown to increase with advancing age. The histological prevalence of BPH at autopsy is as high as 50% to 60% for males in their 60s, increasing to 80% to 90% of those older than 70 years of age. […] Several definitions exist in the literature when describing BPH. These include bladder outlet obstruction, LUTS, and benign prostatic enlargement (BPE). BPH describes the histological changes, BPE refers to the increased size of the gland (usually secondary to BPH), and bladder outlet obstruction is defined as the blockage to urinary flow. […] Lower urinary tract symptoms (LUTS) describe the urinary abnormalities shared by disorders affecting the bladder and prostate, typically caused by BPH.

• #4 Benign prostatic hyperplasia (BPH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

  For BPH, some questions to ask your health care provider are: […] What kinds of tests do I need? […] What are my treatment options? […] Your provider is likely to ask you some questions. Be ready to answer them. It might give you more time to talk about your concerns. […] You’ll probably be asked questions about your symptoms, such as: […] How often do you pee during the day? And how often do you need to get up at night to pee? […] Do you have a frequent or urgent need to pee? […] Is it hard for you to start peeing? Do you start and stop when you urinate, or feel like you have to strain to urinate? […] Does it ever feel like you haven’t fully emptied your bladder? […] Is there any burning when you pee, pain in your bladder area or blood in your urine? Have you had urinary tract infections?

• #5 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. […] The initial evaluation should assess the frequency and severity of symptoms and the impact of symptoms on the patient’s quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. […] The initial evaluation should also include a digital rectal examination and urinalysis. Men with hematuria should be evaluated for bladder cancer. […] A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer. […] For men with mild symptoms, watchful waiting with annual reassessment is appropriate.

• #6 Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment for Medicine

  https://www.picmonic.com/pathways/medicine/courses/standard/pathology-196/prostate-disorders-39447/benign-prostatic-hyperplasia-bph-diagnosis-and-treatment_1403

  Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment […] Accurately diagnosing BPH is extremely important as more serious conditions, such as prostate cancer must be ruled out. […] The examiner palpates the prostate to examine for nodules and asymmetry. The presence of these suggest prostate cancer and not BPH. […] Urinalysis is performed to rule out infection or presence of blood, which indicate other serious pathology that may require treatment. […] Men who develop serious complications, such as hydronephrosis or renal failure may require transurethral resection of the prostate (TURP), surgery to remove the prostate.

• #7 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Recommended tests for men with symptoms of BPH include serum prostate-specific antigen and urinalysis. […] The initial history and physical examination focus on excluding etiologies of lower urinary tract infections other than BPH. […] The physical examination should include a digital rectal examination assessing prostate size, nodularity, and asymmetry, which may raise suspicion for malignancy. […] BPH severity is quantified using a validated, self-administered symptom questionnaire such as the AUA Symptom Index (AUA-SI) or International Prostate Symptom Score (I-PSS). […] Recommended tests are serum prostate-specific antigen (PSA) measurement and urinalysis. […] Mild symptoms (AUA-SI score of 0 to 7) as well as nonbothersome moderate (8 to 19) to severe (20 to 35) symptoms require no treatment. Individuals bothered by moderate to severe lower urinary tract symptoms can be treated with lifestyle modifications, medications, and surgery.

• #8 Benign prostatic hyperplasia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/208

  Benign prostatic hyperplasia (BPH) presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining). […] Physical examination may demonstrate prostate size/volume 30 g, nodules or tenderness suspicious of prostate cancer or prostatitis. […] Evaluation includes history and examination including an abdominal examination for a palpable bladder, a digital rectal exam, and a neurological assessment. […] Urinalysis, prostate-specific antigen (PSA) level, and International Prostate Symptom Score are first-line tests of powerful diagnostic impact in the appropriate patient groups. […] Given the debate regarding the morbidity and mortality reduction of prostate cancer with PSA testing, discuss the implications with the patient before testing.

• #9 Benign prostatic hyperplasia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/208

  Benign prostatic hyperplasia (BPH) presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining). […] Evaluation includes history and examination including an abdominal exam for a palpable bladder, a digital rectal exam, and a neurologic assessment. […] Urinalysis, prostate-specific antigen (PSA) level, and International Prostate Symptom Score are first-line tests of powerful diagnostic impact in the appropriate patient groups. […] Diagnostic tests include urinalysis, prostate-specific antigen (PSA), symptom score questionnaire, frequency/volume chart and voiding diary. […] Tests to consider include ultrasound, CT or MRI abdomen/pelvis, cystoscopy, Postvoid residual (PVR) assessment, uroflowmetry, pressure flow urodynamic studies, assessment of renal function.

• #10 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Benign prostatic hyperplasia (BPH) is a common condition that increases in prevalence with age. A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms. Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment. Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms. BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score. […] The physician must determine if the symptoms are secondary to BPH or other causes and provide appropriate treatment. This article provides evidence-based answers to common questions about the diagnosis and management of BPH.

• #11 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The goal of this revised guideline is to provide a useful reference on the effective evidence-based surgical management of male lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). […] In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle) […] Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy. Revaluation should include the IPSS. Further evaluation may include a post-void residual (PVR) and uroflowmetry. (Clinical Principle)

• #12 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Benign-Prostatic-Hyperplasia-(BPH).aspx

  Benign Prostatic Hyperplasia (BPH) is one of the most common conditions affecting older men. Diagnosis is usually made based on symptoms, a physical examination and some imaging studies. […] The steps involved in diagnosing BPH include: […] A detailed history of the symptoms and any similar conditions among first-degree male relatives (such as father and brothers) is obtained. Patients may be asked to maintain a voiding chart to record their urine flow. […] The International Prostate Symptom Score (IPSS) is a scoring system used to screen for and diagnose benign BPH as well as to monitor symptoms and guide decisions about how to manage the disease. […] The combined score is obtained to give an idea of the extent of BPH, with a score of 0 to 7, representing mild symptoms, 8 to 19 moderate symptoms and 20 to 35 severe symptoms.

• #13

  https://www.gleneagles.com.sg/conditions-diseases/benign-prostate-hyperplasia/diagnosis-treatment

  How is prostate enlargement (BPH) diagnosed? The doctor will first check your medical history and ask about your symptoms. Further investigations will include diagnostic tests such as: Digital rectal examination, in which the doctor will insert a gloved, lubricated finger into your rectum to feel the prostate, so as to evaluate its size and any abnormalities. Urine flow test (uroflowmetry), to measure the speed and strength of your urinary stream. Post-void residual volume test, to see if you are able to empty your bladder completely and measure how much urine remains in the bladder after you finish urinating. Urine analysis test, to screen for bladder cancer and rule out other possible causes for your symptoms. Cystoscopy, a scope to examine your bladder and urethra. Prostate-specific antigen (PSA) blood test, to check if PSA levels are elevated, which might indicate an inflammation or prostate cancer. A PSA test will allow you to detect prostate problems early, even when there are no symptoms.

• #14 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  The AUA recommends urinalysis for all men presenting with lower urinary tract symptoms. Normal urinalysis findings help rule out non-BPH causes of the symptoms, such as bladder cancer, bladder stones, UTI, or urethral strictures. […] Prostate-specific antigen (PSA) levels should be measured in men who have at least a 10-year life expectancy and who would be a candidate for prostate cancer treatment. […] PSA levels correlate with the risk of symptom progression; men with elevated PSA levels respond better to finasteride. […] The 5-alpha reductase inhibitors do not provide immediate symptom relief, and approximately six months of therapy is required to achieve clinical benefit. […] The significance of this finding is unclear because finasteride may cause artifactual changes in prostate cancer histology.

• #15 Benign Prostatic Hyperplasia (BPH): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/437359-overview

  Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate, leading to an enlarged prostate gland. […] The digital rectal examination (DRE) is an integral part of the evaluation in men with presumed BPH. With the DRE, the examiner can assess prostate size and contour, evaluate for nodules, and detect areas suggestive of malignancy. […] Urinalysis – Examine the urine using dipstick methods and/or via centrifuged sediment evaluation to assess for the presence of blood, leukocytes, bacteria, protein, or glucose. […] Prostate-specific antigen (PSA) – Although BPH does not cause prostate cancer, men at risk for BPH are also at risk for this disease and should be screened accordingly (although screening for prostate cancer remains controversial).

• #16 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Urine flow studies (flowmetry) determine peak urinary flow rates. This can help establish whether there is objective evidence for urinary obstruction. […] Prostate-specific antigen testing is somewhat predictive of prostate volume. Benign prostates of 35 cc size will typically generate a PSA of 1.5 ng/mL. PSA testing is recommended where cancer is suspected (hard prostatic nodule, asymmetry, metastatic disease suspected) or a previous baseline PSA has been previously established. […] Patients who fail or do not tolerate medical therapy should undergo further evaluation and consider surgical intervention. […] Surgical management of BPH has broadened significantly over the years, with the development of further minimally invasive techniques. Current recommended procedures include TURP and newer techniques, such as laser vaporization and holmium laser enucleation, which have largely replaced open prostatectomy.

• #17 BPH Diagnosis: Tests For Diagnosing An Enlarged Prostate

  https://www.webmd.com/men/prostate-enlargement-bph/tests-for-bph

  PSA test. This checks for levels of whats called prostate specific antigen, or PSA, in your blood. PSA is a protein your prostate makes. Both BPH and prostate cancer can raise your PSA level. This test alone can’t confirm that you have BPH. You will need other tests, too. If your level is high and your doctor suspects cancer, you’ll likely have a prostate biopsy. […] Cystoscopy. This test lets the doctor see inside your urethra and bladder. You will first get medicine so you don’t feel pain. You are usually awake for this quick procedure. There may be mild discomfort, which the local anesthesia helps with. […] Biopsy. For this test, you will first get medicine so you don’t feel any pain. The doctor will use an ultrasound, CT, or MRI scan to see your prostate gland. They will then use a needle to take a piece of tissue. The sample will be sent to a lab where a technician will look at it under a microscope to see whether it is cancerous.

• #18 Benign prostatic hyperplasia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/208

  Benign prostatic hyperplasia (BPH) presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining). […] Physical examination may demonstrate prostate size/volume 30 g, nodules or tenderness suspicious of prostate cancer or prostatitis. […] Evaluation includes history and examination including an abdominal examination for a palpable bladder, a digital rectal exam, and a neurological assessment. […] Urinalysis, prostate-specific antigen (PSA) level, and International Prostate Symptom Score are first-line tests of powerful diagnostic impact in the appropriate patient groups. […] Given the debate regarding the morbidity and mortality reduction of prostate cancer with PSA testing, discuss the implications with the patient before testing.

• #19 Review and update of benign prostatic hyperplasia in general practice

  https://www1.racgp.org.au/ajgp/2018/july/benign-prostatic-hyperplasia

  Initial investigations aim to exclude sinister causes of LUTS or complications of bladder outflow obstruction that require immediate treatment. […] Prostate-specific antigen (PSA) testing remains controversial both in Australia and internationally. […] Treatment is mostly determined by bother of symptoms, effect on QoL or whether any complicating features are identified. […] Men with bothersome symptoms in the absence of complicating factors are appropriate candidates for a trial of medical therapy. […] Alpha-1 adrenoceptor blockade results in smooth muscle relaxation in the prostate and bladder neck. […] 5-ARIs inhibit the conversion of testosterone to dihydrotestosterone (DHT) to reduce prostate growth and prostate volume. […] Since 2016, tamsulosin plus dutasteride has been available to GPs to prescribe as a combined formulation without specialist approval.

• #20 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Urine flow studies (flowmetry) determine peak urinary flow rates. This can help establish whether there is objective evidence for urinary obstruction. […] Prostate-specific antigen testing is somewhat predictive of prostate volume. Benign prostates of 35 cc size will typically generate a PSA of 1.5 ng/mL. PSA testing is recommended where cancer is suspected (hard prostatic nodule, asymmetry, metastatic disease suspected) or a previous baseline PSA has been previously established. […] Patients who fail or do not tolerate medical therapy should undergo further evaluation and consider surgical intervention. […] Surgical management of BPH has broadened significantly over the years, with the development of further minimally invasive techniques. Current recommended procedures include TURP and newer techniques, such as laser vaporization and holmium laser enucleation, which have largely replaced open prostatectomy.

• #21 Benign Prostatic Hyperplasia (BPH): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/437359-overview

  Ultrasonography (abdominal, renal, transrectal) is useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of kidney insufficiency. […] Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected. […] The severity of BPH can be determined with the International Prostate Symptom Score (IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of life (QOL) question. […] Flow rate – Useful in the initial assessment and to help determine the patients response to treatment. […] Transurethral resection of the prostate (TURP) – The criterion standard for relieving BOO secondary to BPH. […] Patients with mild LUTS can be treated initially with medical therapy. Transurethral resection of the prostate (TURP) is considered the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH.

• #22 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should consider assessment of prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, or cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/ computed tomography [CT]) if such studies are available, prior to intervention for LUTS/BPH. (Clinical Principle) […] Clinicians should perform a PVR assessment prior to intervention for LUTS/BPH. (Clinical Principle) […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) […] TURP should be offered as a treatment option for patients with LUTS/BPH. (Moderate Recommendation; Evidence Level: Grade B)

• #23 Benign Prostatic Hyperplasia (BPH) | Duke Health

  https://www.dukehealth.org/treatments/urology/benign-prostatic-hyperplasia

  Frequent urination, an overwhelming urge to urinate, difficulty urinating, and urinary leakage are uncomfortable symptoms that may be signs of benign prostatic hyperplasia (BPH), typically known as an enlarged prostate. […] Dukes urologists are experts in diagnosing and treating enlarged prostates. […] In addition to an in-depth discussion of your urinary symptoms and a review of your medical history, more testing may be required. […] A urine test checks for things such as blood and inflammation. It can assess whether a bladder infection may be causing your symptoms. […] A uroflow test measures the speed of your urinary stream. Slower than normal rates may indicate that an enlarged prostate is reducing the stream. […] After you urinate, your urologist may use ultrasound to see how much urine is left in your bladder. This may identify a blockage or signs of bladder dysfunction.

• #24 Benign Prostatic Hyperplasia (BPH): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/437359-overview

  Ultrasonography (abdominal, renal, transrectal) is useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of kidney insufficiency. […] Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected. […] The severity of BPH can be determined with the International Prostate Symptom Score (IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of life (QOL) question. […] Flow rate – Useful in the initial assessment and to help determine the patients response to treatment. […] Transurethral resection of the prostate (TURP) – The criterion standard for relieving BOO secondary to BPH. […] Patients with mild LUTS can be treated initially with medical therapy. Transurethral resection of the prostate (TURP) is considered the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH.

• #25 Benign Prostatic Hyperplasia (BPH): Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/benign-prostatic-hyperplasia-bph

  The doctor may recommend the following tests: […] Uroflowmetry (UFM): Evaluate the dynamic flow rate of the urinary stream during voiding. […] Transrectal ultrasound: A special rectal ultrasound probe provides a detailed picture of your prostate. […] Prostate biopsy: To rule out suspected prostate cancer. […] Cystoscopy: A cystoscope will be inserted through your urethra into the bladder under topical anesthetic for a direct view of the urethra and the inside of the bladder.

• #26 Benign Prostatic Hyperplasia (BPH): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/437359-overview

  Ultrasonography (abdominal, renal, transrectal) is useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of kidney insufficiency. […] Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected. […] The severity of BPH can be determined with the International Prostate Symptom Score (IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of life (QOL) question. […] Flow rate – Useful in the initial assessment and to help determine the patients response to treatment. […] Transurethral resection of the prostate (TURP) – The criterion standard for relieving BOO secondary to BPH. […] Patients with mild LUTS can be treated initially with medical therapy. Transurethral resection of the prostate (TURP) is considered the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH.

• #27 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should consider assessment of prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, or cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/ computed tomography [CT]) if such studies are available, prior to intervention for LUTS/BPH. (Clinical Principle) […] Clinicians should perform a PVR assessment prior to intervention for LUTS/BPH. (Clinical Principle) […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) […] TURP should be offered as a treatment option for patients with LUTS/BPH. (Moderate Recommendation; Evidence Level: Grade B)

• #28 Benign prostatic hyperplasia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/208

  Diagnostic investigations include urinalysis, prostate-specific antigen (PSA), symptom score questionnaire, frequency/volume chart and voiding diary. […] Investigations to consider include ultrasound, CT or MRI abdomen/pelvis, cystoscopy, Post-void residual (PVR) assessment, uroflowmetry, pressure flow urodynamic studies, assessment of renal function.

• #29 BPH diagnosis – Information collected to determine suitable treatments – Prostate Matters

  https://prostatematters.co.uk/bph-diagnosis-information-collected-to-determine-suitable-treatments/

  Benign Prostatic Hyperplasia (BPH) diagnosis Information collected to determine suitable treatments […] The first step is to assess the severity of the symptoms. This is determined using the International Prostate Symptom Score. […] The IPSS is an eight question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH). […] A good estimate of prostate volume is critical in determining which treatments can be offered. […] Multiparametric MRI (see under Prostate Cancer Diagnosis) is the gold standard for accurately determining prostate volume. […] Transrectal Ultrasound (TRUS) is the most commonly used method. […] Digital (finger) rectal examination (DRE) is sometimes used, though DRE tends to give a rather poor estimate of volume and should be avoided.

• #30 Benign Prostatic Hyperplasia – Men’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/men-s-health-issues/benign-prostate-disorders/benign-prostatic-hyperplasia

  If doctors suspect prostate cancer, they may use transrectal ultrasound (TRUS) to help identify the areas most likely to have cancer and target them for biopsy. […] In men with high or increasing PSA levels, a technology called multiparametric MRI may be used to enhance diagnosis and treatment of BPH and exclude prostate cancer. […] Treatment is not necessary unless BPH causes especially bothersome symptoms or complications (such as urinary tract infections, impaired kidney function, blood in the urine, stones, or urinary retention). […] Medications are usually tried first. […] If medications are ineffective, surgery can be done. […] The most common surgical procedure is transurethral resection of the prostate (TURP), in which a doctor passes an endoscope (a viewing tube) through the urethra. […] TURP can lead to such complications as infection and bleeding. […] Transurethral incision of the prostate (TUIP) is an alternative surgical procedure to treat BPH. […] Various other alternative treatments offer less rapid symptom relief than TURP.

• #31 Benign Prostatic Hyperplasia (BPH): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/437359-overview

  Ultrasonography (abdominal, renal, transrectal) is useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of kidney insufficiency. […] Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected. […] The severity of BPH can be determined with the International Prostate Symptom Score (IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of life (QOL) question. […] Flow rate – Useful in the initial assessment and to help determine the patients response to treatment. […] Transurethral resection of the prostate (TURP) – The criterion standard for relieving BOO secondary to BPH. […] Patients with mild LUTS can be treated initially with medical therapy. Transurethral resection of the prostate (TURP) is considered the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH.

• #32 Benign Prostatic Hyperplasia (BPH): Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/benign-prostatic-hyperplasia-bph

  The doctor may recommend the following tests: […] Uroflowmetry (UFM): Evaluate the dynamic flow rate of the urinary stream during voiding. […] Transrectal ultrasound: A special rectal ultrasound probe provides a detailed picture of your prostate. […] Prostate biopsy: To rule out suspected prostate cancer. […] Cystoscopy: A cystoscope will be inserted through your urethra into the bladder under topical anesthetic for a direct view of the urethra and the inside of the bladder.

• #33 Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate – Urology | UCLA Health

  https://www.uclahealth.org/medical-services/urology/conditions-treated/male-conditions/benign-prostatic-hyperplasia-bph

  Benign prostatic hyperplasia (BPH) is a non-cancerous condition that affects a substantial number of men as they age. In BPH an enlarged prostate can squeeze or partially block the urethra the tube that carries the urine from the bladder out of the body. This can lead to bothersome urinary symptoms that may include a weak stream, trouble starting and stopping, the frequent feeling of needing to urinate, greater urgency when the feeling hits, leaking or dribbling, and the sense that the bladder isnt empty after urination. These symptoms can be detrimental to a patients health and quality of life, and can easily be treated with medications and procedures. […] The symptoms of BPH often bring patients to their doctor. An enlarged prostate can be diagnosed during a routine digital rectal examination. Other common tests used to diagnose BPH include a urine flow study, which uses a device that measures the speed of the stream; a transrectal ultrasound to measure the size of the prostate gland, and a visual exam called cystoscopy, which uses a flexible camera inserted into the urethra to view the prostate and bladder.

• #34 Benign Prostatic Hyperplasia – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/benign-prostatic-hyperplasia

  Interpreting prostate-specific antigen (PSA) levels can be complex. […] Clinical judgment must be used to evaluate the need for further testing. […] Cystoscopy with or without urodynamics can be useful in looking for other causes of obstruction such as urethral strictures and in determining the optimal surgical approach if a procedure is required.

• #35 Benign prostatic hyperplasia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/208

  Diagnostic investigations include urinalysis, prostate-specific antigen (PSA), symptom score questionnaire, frequency/volume chart and voiding diary. […] Investigations to consider include ultrasound, CT or MRI abdomen/pelvis, cystoscopy, Post-void residual (PVR) assessment, uroflowmetry, pressure flow urodynamic studies, assessment of renal function.

• #36 Diagnosis of Benign Prostatic Hyperplasia – ROC Clinic

  https://rocclinic.com/en/benign-prostatic-hyperplasia/diagnosis/

  Ultrasound of the bladder to determine if urine remains after emptying the bladder. […] To rule out the presence of a bladder tumor, urethral stricture, urinary tract infection, bladder lithiasis or overactive bladder, tests such as renovesicoprostatic ultrasound and urinary cytology will be performed. […] Once the above is ruled out, it will be determined whether benign prostatic hyperplasia may be producing complications secondary to obstruction, such as bladder lithiasis, repeated urinary tract infections, chronic urinary retention, hydronephrosis or the presence of chronic renal insufficiency. […] In addition, the risk of prostate disease progression will be calculated using PSA and prostate volume (by ultrasound). […] Finally, tests are performed to help detect bladder obstruction. The simplest of these is urinary flowmetry, which allows the volume of urine per unit of time to be measured. […] In cases where more diagnostic power is needed, urodynamics can be performed. This is a more invasive test performed by inserting a small bladder and rectal catheter to measure bladder and abdominal pressures.

• #37 Benign prostatic hyperplasia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/benign-prostatic-hyperplasia/

  Suspect BPH in patients 45 years of age with uncomplicated LUTS. […] Initial assessment: Determine if LUTS is attributable to BPH. […] Assess the severity of LUTS using either the IPSS or the AUA-SI scores. […] Serum PSA level: to aid selection of pharmacotherapy for BPH or if detection of prostate cancer will alter management. […] Urodynamic studies can help identify the predominant type of LUTS (i.e., voiding LUTS or storage LUTS). […] Imaging in patients with LUTS attributable to BPH is indicated to assess prostate size and morphology, if the results may affect treatment selection. […] Transurethral resection of the prostate (TURP) is the gold standard treatment of BPH. However, pharmacotherapy can delay or even prevent the need to undergo surgery and should be considered as a first-line option in all patients with uncomplicated bothersome LUTS attributable to BPH.

• #38 Benign prostatic hyperplasia: diagnosis and management

  https://pavilionhealthtoday.com/gm/benign-prostatic-hyperplasia/

  Benign prostatic hyperplasia (BPH) is the expansion of both epithelial and stromal components of the prostate gland and is now considered a purely histological diagnosis. Benign prostatic hyperplasia is a common condition encountered in aging men and a common cause of lower urinary tract symptoms (LUTS). […] It is estimated that 72.3% of men suffer from one or more of the symptoms on at least one occasion whereas in 47.9% this occurs frequently. […] When BPH results in a clinical enlargement of the prostate gland, as occurs in approximately 50% of cases, the term benign prostatic enlargement (BPE) is applied. […] It is of note that BOO is a urodynamic, which can be suspected to be present from a flow rate and post-voiding residual measurement but can only be confirmed by the use of a synchronous pressure/flow urodynamic study with the findings of a low urinary flow and high detrusor muscle pressure.

• #39 Benign Prostatic Hyperplasia (BPH) Differential Diagnoses

  https://emedicine.medscape.com/article/437359-differential

  Symptoms often attributed to benign prostatic hyperplasia (BPH) can be caused by any of the following conditions: […] Excluding these entities based on findings from a thorough history and appropriately directed diagnostic studies is essential. […] The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. […] Benign Prostatic Hyperplasia: Diagnosis and Treatment.

• #40 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Water vapor thermal infusion is primarily an office-based procedure designed for prostates 30 cc to 80 cc in size. […] Transurethral microwave thermotherapy is an outpatient procedure to treat BPH that uses a microwave antenna inserted transurethrally into the prostatic urethra to treat obstructing tissue. […] Selective prostatic artery embolization can be effective for controlling otherwise intractable prostatic bleeding. […] The 2021 AUA Guidelines on Management of BPH/LUTS no longer recommend transurethral needle ablation (TUNA) due to its unpredictable and unreliable results. […] Differential diagnoses for LUTS are broad and include bladder neck strictures, bladder or prostate cancer, high-pressure chronic retention, and urinary tract infections. […] Observational studies have demonstrated that when left without treatment, clinical progression of BPH increased over 48 months, with 31% of the cohort requiring further treatment and 5% developing acute retention in the same period. […] The risk of acute urinary retention increases with age. […] Common complications of BPH include acute urinary retention, chronic urinary retention, urinary tract infections, and postoperative incontinence.

• #41 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Water vapor thermal infusion is primarily an office-based procedure designed for prostates 30 cc to 80 cc in size. […] Transurethral microwave thermotherapy is an outpatient procedure to treat BPH that uses a microwave antenna inserted transurethrally into the prostatic urethra to treat obstructing tissue. […] Selective prostatic artery embolization can be effective for controlling otherwise intractable prostatic bleeding. […] The 2021 AUA Guidelines on Management of BPH/LUTS no longer recommend transurethral needle ablation (TUNA) due to its unpredictable and unreliable results. […] Differential diagnoses for LUTS are broad and include bladder neck strictures, bladder or prostate cancer, high-pressure chronic retention, and urinary tract infections. […] Observational studies have demonstrated that when left without treatment, clinical progression of BPH increased over 48 months, with 31% of the cohort requiring further treatment and 5% developing acute retention in the same period. […] The risk of acute urinary retention increases with age. […] Common complications of BPH include acute urinary retention, chronic urinary retention, urinary tract infections, and postoperative incontinence.

• #42 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. […] The initial evaluation should assess the frequency and severity of symptoms and the impact of symptoms on the patient’s quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. […] The initial evaluation should also include a digital rectal examination and urinalysis. Men with hematuria should be evaluated for bladder cancer. […] A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer. […] For men with mild symptoms, watchful waiting with annual reassessment is appropriate.

• #43 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Water vapor thermal infusion is primarily an office-based procedure designed for prostates 30 cc to 80 cc in size. […] Transurethral microwave thermotherapy is an outpatient procedure to treat BPH that uses a microwave antenna inserted transurethrally into the prostatic urethra to treat obstructing tissue. […] Selective prostatic artery embolization can be effective for controlling otherwise intractable prostatic bleeding. […] The 2021 AUA Guidelines on Management of BPH/LUTS no longer recommend transurethral needle ablation (TUNA) due to its unpredictable and unreliable results. […] Differential diagnoses for LUTS are broad and include bladder neck strictures, bladder or prostate cancer, high-pressure chronic retention, and urinary tract infections. […] Observational studies have demonstrated that when left without treatment, clinical progression of BPH increased over 48 months, with 31% of the cohort requiring further treatment and 5% developing acute retention in the same period. […] The risk of acute urinary retention increases with age. […] Common complications of BPH include acute urinary retention, chronic urinary retention, urinary tract infections, and postoperative incontinence.

• #44 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Water vapor thermal infusion is primarily an office-based procedure designed for prostates 30 cc to 80 cc in size. […] Transurethral microwave thermotherapy is an outpatient procedure to treat BPH that uses a microwave antenna inserted transurethrally into the prostatic urethra to treat obstructing tissue. […] Selective prostatic artery embolization can be effective for controlling otherwise intractable prostatic bleeding. […] The 2021 AUA Guidelines on Management of BPH/LUTS no longer recommend transurethral needle ablation (TUNA) due to its unpredictable and unreliable results. […] Differential diagnoses for LUTS are broad and include bladder neck strictures, bladder or prostate cancer, high-pressure chronic retention, and urinary tract infections. […] Observational studies have demonstrated that when left without treatment, clinical progression of BPH increased over 48 months, with 31% of the cohort requiring further treatment and 5% developing acute retention in the same period. […] The risk of acute urinary retention increases with age. […] Common complications of BPH include acute urinary retention, chronic urinary retention, urinary tract infections, and postoperative incontinence.

• #45 Benign Prostatic Hyperplasia: Evaluation and Medical Management in Primary Care

  https://consultqd.clevelandclinic.org/benign-prostatic-hyperplasia-evaluation-and-medical-management-in-primary-care

  All men with lower urinary tract symptoms should complete the International Prostate Symptom Score (IPSS) survey, consisting of seven questions about urinary symptoms plus one about quality of life. […] Urinalysis is recommended to assess for urinary tract infection, hematuria, proteinuria or glucosuria. […] Prostate-specific antigen (PSA) utility extends to guiding the management of BPH. PSA levels correlate with prostate volume and subsequent growth. […] If the initial evaluation reveals hematuria, recurrent urinary tract infection, a palpable bladder, abnormal findings on digital rectal examination suggesting prostate cancer, or a history of or risk factors for urethral stricture or neurologic disease, the patient should be referred to a urologist for further evaluation. […] Patients referred for urologic evaluation may require additional tests for diagnosis and to guide management.

• #46 Benign Prostatic Hyperplasia (BPH) Differential Diagnoses

  https://emedicine.medscape.com/article/437359-differential

  Symptoms often attributed to benign prostatic hyperplasia (BPH) can be caused by any of the following conditions: […] Excluding these entities based on findings from a thorough history and appropriately directed diagnostic studies is essential. […] The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. […] Benign Prostatic Hyperplasia: Diagnosis and Treatment.

• #47 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Recommended tests for men with symptoms of BPH include serum prostate-specific antigen and urinalysis. […] The initial history and physical examination focus on excluding etiologies of lower urinary tract infections other than BPH. […] The physical examination should include a digital rectal examination assessing prostate size, nodularity, and asymmetry, which may raise suspicion for malignancy. […] BPH severity is quantified using a validated, self-administered symptom questionnaire such as the AUA Symptom Index (AUA-SI) or International Prostate Symptom Score (I-PSS). […] Recommended tests are serum prostate-specific antigen (PSA) measurement and urinalysis. […] Mild symptoms (AUA-SI score of 0 to 7) as well as nonbothersome moderate (8 to 19) to severe (20 to 35) symptoms require no treatment. Individuals bothered by moderate to severe lower urinary tract symptoms can be treated with lifestyle modifications, medications, and surgery.

• #48 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The goal of this revised guideline is to provide a useful reference on the effective evidence-based surgical management of male lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). […] In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle) […] Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy. Revaluation should include the IPSS. Further evaluation may include a post-void residual (PVR) and uroflowmetry. (Clinical Principle)

• #49 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should consider assessment of prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, or cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/ computed tomography [CT]) if such studies are available, prior to intervention for LUTS/BPH. (Clinical Principle) […] Clinicians should perform a PVR assessment prior to intervention for LUTS/BPH. (Clinical Principle) […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) […] TURP should be offered as a treatment option for patients with LUTS/BPH. (Moderate Recommendation; Evidence Level: Grade B)

• #50 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Water vapor thermal infusion is primarily an office-based procedure designed for prostates 30 cc to 80 cc in size. […] Transurethral microwave thermotherapy is an outpatient procedure to treat BPH that uses a microwave antenna inserted transurethrally into the prostatic urethra to treat obstructing tissue. […] Selective prostatic artery embolization can be effective for controlling otherwise intractable prostatic bleeding. […] The 2021 AUA Guidelines on Management of BPH/LUTS no longer recommend transurethral needle ablation (TUNA) due to its unpredictable and unreliable results. […] Differential diagnoses for LUTS are broad and include bladder neck strictures, bladder or prostate cancer, high-pressure chronic retention, and urinary tract infections. […] Observational studies have demonstrated that when left without treatment, clinical progression of BPH increased over 48 months, with 31% of the cohort requiring further treatment and 5% developing acute retention in the same period. […] The risk of acute urinary retention increases with age. […] Common complications of BPH include acute urinary retention, chronic urinary retention, urinary tract infections, and postoperative incontinence.

• #51 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should consider assessment of prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, or cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/ computed tomography [CT]) if such studies are available, prior to intervention for LUTS/BPH. (Clinical Principle) […] Clinicians should perform a PVR assessment prior to intervention for LUTS/BPH. (Clinical Principle) […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) […] TURP should be offered as a treatment option for patients with LUTS/BPH. (Moderate Recommendation; Evidence Level: Grade B)

• #52 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  The AUA recommends urinalysis for all men presenting with lower urinary tract symptoms. Normal urinalysis findings help rule out non-BPH causes of the symptoms, such as bladder cancer, bladder stones, UTI, or urethral strictures. […] Prostate-specific antigen (PSA) levels should be measured in men who have at least a 10-year life expectancy and who would be a candidate for prostate cancer treatment. […] PSA levels correlate with the risk of symptom progression; men with elevated PSA levels respond better to finasteride. […] The 5-alpha reductase inhibitors do not provide immediate symptom relief, and approximately six months of therapy is required to achieve clinical benefit. […] The significance of this finding is unclear because finasteride may cause artifactual changes in prostate cancer histology.

• #53 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The goal of this revised guideline is to provide a useful reference on the effective evidence-based surgical management of male lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). […] In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle) […] Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy. Revaluation should include the IPSS. Further evaluation may include a post-void residual (PVR) and uroflowmetry. (Clinical Principle)

• #54 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. […] The initial evaluation should assess the frequency and severity of symptoms and the impact of symptoms on the patient’s quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. […] The initial evaluation should also include a digital rectal examination and urinalysis. Men with hematuria should be evaluated for bladder cancer. […] A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer. […] For men with mild symptoms, watchful waiting with annual reassessment is appropriate.

• #55 Benign Prostatic Hyperplasia (BPH) | Doctor

  https://patient.info/doctor/benign-prostatic-hyperplasia

  Imaging may also be necessary if there is any suggestion of urinary tract obstruction. […] Any uncertainty about diagnosis requires a referral to urology where further investigations may be required. […] NICE recommends referral for the following: Acute retention of urine (admit immediately), Acute kidney injury (admit immediately), Visible haematuria (depending on age and other symptoms) – urgent cancer referral, Suspicion of prostate cancer based on the finding of a nodular or firm prostate, or a raised PSA level, or both – urgent cancer referral. […] If symptoms are minimal, 'watchful waiting’ (WW) is the most judicious option, provided that malignancy has been excluded. […] Several drugs have been shown to be useful to control the condition. […] Surgery is usually reserved for those with a large prostate gland or failure to respond to an adequate trial of medical therapy.

• #56 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians may use a monopolar or bipolar approach to TURP as a treatment option, depending on their expertise with these techniques. (Expert Opinion) […] HoLEP, PVP, and ThuLEP should be considered as treatment options in patients who are at higher risk of bleeding. (Expert Opinion) […] 5-ARIs may be an appropriate and effective treatment alternative in men with refractory hematuria presumably due to prostatic bleeding. (Expert Opinion) […] 5-ARIs alone or in combination with alpha blockers are recommended as a treatment option to prevent progression of LUTS/BPH and/or reduce the risks of urinary retention and need for future prostate-related surgery. (Strong Recommendation; Evidence Level: Grade A) […] Clinicians may consider 5-ARIs as a treatment option to reduce intraoperative bleeding and peri- or postoperative need for blood transfusion after transurethral resection of the prostate (TURP) or other surgical intervention for BPH. (Expert Opinion)

• #57 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  For patients with LUTS/BPH irrespective of comorbid erectile dysfunction (ED), 5mg daily tadalafil should be discussed as a treatment option. (Moderate Recommendation; Evidence Level: Grade B) […] 5-ARI in combination with an alpha blocker should be offered as a treatment option only to patients with LUTS associated with demonstrable prostatic enlargement as judged by a prostate volume of 30g on imaging, a PSA 1.5ng/mL, or palpable prostate enlargement on DRE. (Strong Recommendation; Evidence Level: Grade A) […] Anticholinergic agents, alone or in combination with an alpha blocker, may be offered as a treatment option to patients with moderate to severe predominant storage LUTS. (Conditional Recommendation; Evidence Level: Grade C) […] Beta-3-agonists in combination with an alpha blocker may be offered as a treatment option to patients with moderate to severe predominate storage LUTS. (Conditional Recommendation; Evidence Level: Grade C)

• #58 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians may offer the combination of low-dose daily 5mg tadalafil with alpha blockers for the treatment of LUTS/BPH. (Conditional Recommendation; Evidence Level: Grade C) […] Clinicians may offer the combination of low dose daily tadalafil 5mg with finasteride for the treatment of LUTS/BPH. (Conditional Recommendation; Evidence Level: Grade C) […] Physicians should prescribe an oral alpha blocker prior to a voiding trial to treat patients with AUR related to BPH. (Moderate Recommendation; Evidence Level: Grade B) […] Patients newly treated for AUR with alpha blockers should complete at least three days of medical therapy prior to attempting trial without a catheter (TWOC). (Expert Opinion) […] Clinicians should inform patients who pass a successful TWOC for AUR from BPH that they remain at increased risk for recurrent urinary retention. (Moderate Recommendation; Evidence Level: Grade C)

• #59 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Surgical treatment options for the management of BPH include transurethral resection of the prostate (TURP), transurethral incision of the prostate, transurethral electrovaporization of the prostate, transurethral laser vaporization, and holmium and thulium laser enucleation of the prostate. […] Aquablation is a minimally invasive robotic-assisted prostatic procedure developed in 2013 and FDA-approved in 2017. It uses a heat-free high-pressure water jet of normal saline to quickly resect and ablate hyperplastic prostatic tissue. […] Prostatic urethra internal lateral suturing (prostatic urethral lift) involves compressing the coapting and obstructing prostate lobes laterally. This allows the urinary channel to be substantially widened without cutting or resectioning the prostate while leaving the bladder neck intact.

• #60 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should consider assessment of prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, or cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/ computed tomography [CT]) if such studies are available, prior to intervention for LUTS/BPH. (Clinical Principle) […] Clinicians should perform a PVR assessment prior to intervention for LUTS/BPH. (Clinical Principle) […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) […] TURP should be offered as a treatment option for patients with LUTS/BPH. (Moderate Recommendation; Evidence Level: Grade B)

• #61 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  Medical therapies for BPH are summarized in Table 3. […] Surgical treatment of BPH may be appropriate if medical treatment fails or the patient develops refractory urinary retention, persistent hematuria, or bladder stones. […] Transurethral resection of the prostate (TURP) is considered the benchmark for surgical therapies because its effectiveness is supported by the most extensive data. […] A randomized trial comparing TURP with watchful waiting showed a reduction in symptoms and complications in men who underwent surgery. […] Newer surgical techniques are intended to provide symptomatic relief while avoiding the morbidity associated with traditional TURP.

• #62 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The goal of this revised guideline is to provide a useful reference on the effective evidence-based surgical management of male lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). […] In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle) […] Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy. Revaluation should include the IPSS. Further evaluation may include a post-void residual (PVR) and uroflowmetry. (Clinical Principle)

• #63 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The goal of this revised guideline is to provide a useful reference on the effective evidence-based surgical management of male lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). […] In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle) […] Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy. Revaluation should include the IPSS. Further evaluation may include a post-void residual (PVR) and uroflowmetry. (Clinical Principle)

• #64 Enlarged Prostate (Benign Prostatic Hyperplasia) – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/enlarged-prostate-benign-prostatic-hyperplasia

  Your health care professional may recommend a medical procedure or device to relieve your BPH symptoms. […] You may need surgery to remove part or all of your prostate if your medicines do not help, your symptoms are severe or bother you, or you develop complications. […] A health care professional may recommend a digital rectal exam once a year or more often to check your prostate.

• #65 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Recommended tests for men with symptoms of BPH include serum prostate-specific antigen and urinalysis. […] The initial history and physical examination focus on excluding etiologies of lower urinary tract infections other than BPH. […] The physical examination should include a digital rectal examination assessing prostate size, nodularity, and asymmetry, which may raise suspicion for malignancy. […] BPH severity is quantified using a validated, self-administered symptom questionnaire such as the AUA Symptom Index (AUA-SI) or International Prostate Symptom Score (I-PSS). […] Recommended tests are serum prostate-specific antigen (PSA) measurement and urinalysis. […] Mild symptoms (AUA-SI score of 0 to 7) as well as nonbothersome moderate (8 to 19) to severe (20 to 35) symptoms require no treatment. Individuals bothered by moderate to severe lower urinary tract symptoms can be treated with lifestyle modifications, medications, and surgery.

• #66 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The goal of this revised guideline is to provide a useful reference on the effective evidence-based surgical management of male lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). […] In the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH, clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle) […] Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy. Revaluation should include the IPSS. Further evaluation may include a post-void residual (PVR) and uroflowmetry. (Clinical Principle)

• #67 Benign prostatic hyperplasia: diagnosis and management

  https://pavilionhealthtoday.com/gm/benign-prostatic-hyperplasia/

  Predictors of disease progression including age 70, large prostate size (30cc), serum PSA1.4ng/ml, IPSS score 7 and failure to respond to alpha-blockers should be kept in mind to identify men at greatest risk of running into trouble. […] It is appropriate to review patients managed conservatively on an annual basis or sooner if their symptoms become more bothersome. […] After drug treatment is commenced, a review appointment should be made to re-assess symptoms improvement in quality of life and any side effects of the medication. […] Several promising new pharmacotherapies are now becoming available but their exact role in the clinical armamentarium is yet to be defined.

• #68 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Benign prostatic hyperplasia (BPH) is a common condition that increases in prevalence with age. A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms. Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment. Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms. BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score. […] The physician must determine if the symptoms are secondary to BPH or other causes and provide appropriate treatment. This article provides evidence-based answers to common questions about the diagnosis and management of BPH.

• #69 Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment for Medicine

  https://www.picmonic.com/pathways/medicine/courses/standard/pathology-196/prostate-disorders-39447/benign-prostatic-hyperplasia-bph-diagnosis-and-treatment_1403

  Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment […] Accurately diagnosing BPH is extremely important as more serious conditions, such as prostate cancer must be ruled out. […] The examiner palpates the prostate to examine for nodules and asymmetry. The presence of these suggest prostate cancer and not BPH. […] Urinalysis is performed to rule out infection or presence of blood, which indicate other serious pathology that may require treatment. […] Men who develop serious complications, such as hydronephrosis or renal failure may require transurethral resection of the prostate (TURP), surgery to remove the prostate.

• #70 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  The AUA recommends urinalysis for all men presenting with lower urinary tract symptoms. Normal urinalysis findings help rule out non-BPH causes of the symptoms, such as bladder cancer, bladder stones, UTI, or urethral strictures. […] Prostate-specific antigen (PSA) levels should be measured in men who have at least a 10-year life expectancy and who would be a candidate for prostate cancer treatment. […] PSA levels correlate with the risk of symptom progression; men with elevated PSA levels respond better to finasteride. […] The 5-alpha reductase inhibitors do not provide immediate symptom relief, and approximately six months of therapy is required to achieve clinical benefit. […] The significance of this finding is unclear because finasteride may cause artifactual changes in prostate cancer histology.

• #71 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Recommended tests for men with symptoms of BPH include serum prostate-specific antigen and urinalysis. […] The initial history and physical examination focus on excluding etiologies of lower urinary tract infections other than BPH. […] The physical examination should include a digital rectal examination assessing prostate size, nodularity, and asymmetry, which may raise suspicion for malignancy. […] BPH severity is quantified using a validated, self-administered symptom questionnaire such as the AUA Symptom Index (AUA-SI) or International Prostate Symptom Score (I-PSS). […] Recommended tests are serum prostate-specific antigen (PSA) measurement and urinalysis. […] Mild symptoms (AUA-SI score of 0 to 7) as well as nonbothersome moderate (8 to 19) to severe (20 to 35) symptoms require no treatment. Individuals bothered by moderate to severe lower urinary tract symptoms can be treated with lifestyle modifications, medications, and surgery.

• #72 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Urine flow studies (flowmetry) determine peak urinary flow rates. This can help establish whether there is objective evidence for urinary obstruction. […] Prostate-specific antigen testing is somewhat predictive of prostate volume. Benign prostates of 35 cc size will typically generate a PSA of 1.5 ng/mL. PSA testing is recommended where cancer is suspected (hard prostatic nodule, asymmetry, metastatic disease suspected) or a previous baseline PSA has been previously established. […] Patients who fail or do not tolerate medical therapy should undergo further evaluation and consider surgical intervention. […] Surgical management of BPH has broadened significantly over the years, with the development of further minimally invasive techniques. Current recommended procedures include TURP and newer techniques, such as laser vaporization and holmium laser enucleation, which have largely replaced open prostatectomy.

• #73 Benign prostatic hyperplasia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/208

  Diagnostic investigations include urinalysis, prostate-specific antigen (PSA), symptom score questionnaire, frequency/volume chart and voiding diary. […] Investigations to consider include ultrasound, CT or MRI abdomen/pelvis, cystoscopy, Post-void residual (PVR) assessment, uroflowmetry, pressure flow urodynamic studies, assessment of renal function.

• #74 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should consider assessment of prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, or cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/ computed tomography [CT]) if such studies are available, prior to intervention for LUTS/BPH. (Clinical Principle) […] Clinicians should perform a PVR assessment prior to intervention for LUTS/BPH. (Clinical Principle) […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) […] TURP should be offered as a treatment option for patients with LUTS/BPH. (Moderate Recommendation; Evidence Level: Grade B)

• #75 Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1201/p769.html

  Benign prostatic hyperplasia (BPH) is a common condition that increases in prevalence with age. A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms. Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment. Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms. BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score. […] The physician must determine if the symptoms are secondary to BPH or other causes and provide appropriate treatment. This article provides evidence-based answers to common questions about the diagnosis and management of BPH.

• #76 Benign Prostatic Hyperplasia (BPH) Differential Diagnoses

  https://emedicine.medscape.com/article/437359-differential

  Symptoms often attributed to benign prostatic hyperplasia (BPH) can be caused by any of the following conditions: […] Excluding these entities based on findings from a thorough history and appropriately directed diagnostic studies is essential. […] The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. […] Benign Prostatic Hyperplasia: Diagnosis and Treatment.

• #77 Benign Prostatic Hyperplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558920/

  Water vapor thermal infusion is primarily an office-based procedure designed for prostates 30 cc to 80 cc in size. […] Transurethral microwave thermotherapy is an outpatient procedure to treat BPH that uses a microwave antenna inserted transurethrally into the prostatic urethra to treat obstructing tissue. […] Selective prostatic artery embolization can be effective for controlling otherwise intractable prostatic bleeding. […] The 2021 AUA Guidelines on Management of BPH/LUTS no longer recommend transurethral needle ablation (TUNA) due to its unpredictable and unreliable results. […] Differential diagnoses for LUTS are broad and include bladder neck strictures, bladder or prostate cancer, high-pressure chronic retention, and urinary tract infections. […] Observational studies have demonstrated that when left without treatment, clinical progression of BPH increased over 48 months, with 31% of the cohort requiring further treatment and 5% developing acute retention in the same period. […] The risk of acute urinary retention increases with age. […] Common complications of BPH include acute urinary retention, chronic urinary retention, urinary tract infections, and postoperative incontinence.

• #78 Navigation Icons-02-svg

  https://friendsdiaper.in/blogs/mens-health/benign-prostatic-hyperplasia-diagnosis-and-treatment?srsltid=AfmBOoo1LlUtz5aWtIYX4Fxujg-F_4QHNA-iFddKhz773elzOu2QhOKs

  BPH or benign prostatic hyperplasia is a common condition in men caused by an enlarged prostate. This enlarged prostate can cause difficulty with urination, by blocking the flow of urine out of the bladder, causing a stop-start urine flow, etc. […] Early diagnosis and treatment of BPH is important, because if BPH is left untreated, it can also cause incontinence involuntary leakage of urine, bladder and kidney damage, bladder stones, and urinary tract infections. […] For your benign prostatic hyperplasia diagnosis, your doctor will start by asking detailed questions about your symptoms, medical history and by doing a physical exam. This initial exam can include: […] Digital rectal examination (DRE): The doctor inserts his finger into your rectum to feel the back wall of the prostate and check it for enlargement.

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