Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms

Patient Guideline Summary

Publication Date: September 14, 2023

Objective

Objective

This patient summary means to summarize key recommendations from the American Urological Association (AUA) for benign prostatic hyperplasia. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Benign prostatic hyperplasia is a medical condition where the prostate gland enlarges, eventually leading to the inability to urinate.
  • We will use the abbreviation BPH throughout this summary to refer to benign prostatic hyperplasia.
  • The prostate gland is the only human organ that keeps growing. As a result, most men suffer difficulty passing urine as they age.
  • Testosterone is the only necessary factor causing BPH.
  • Symptoms include a reduced flow of urine, inability to empty the bladder, and, finally, obstruction of urine flow.
  • This patient summary focuses on the evaluation and medical management. A subsequent AUA Guideline deals with surgical treatment.

Evaluation

Evaluation

  • Other conditions can cause symptoms of BPH, so the initial evaluation requires a complete evaluation.
    • Medical history and physical examination
    • You will produce a urine specimen for testing, fill out an International Prostate Symptom Score (IPSS) questionnaire, and have whatever other tests or imaging your particular medical condition requires.
    • You may also be asked to keep a urination log – time, amount, and related symptoms.
    • Prostate cancer will be investigated.
  • Other tests you may need initially or after a treatment trial include catheterization, cystoscopy, imaging, and measurements of urine flow and pressure.

Medical Treatment

Medical Treatment

  • There are five classes of drugs that reduce symptoms of BPH:
    • 5-alpha-reductase inhibitor (5-ARI)
    • alpha-blockers
    • phosphodiesterase-5 Inhibitor (PDE5)
    • beta-3-agonists
    • anticholinergic agents
  • If you and your doctor agree to try medical treatment you will be prescribed one or more of these medication classes for a few months, followed by an evaluation of how well the treatment is working.
  • If you are completely unable to urinate in spite of medications – acute urinary retention (AUR) – your bladder will have to be emptied with a catheter, and surgical repair must be considered.

Abbreviations

  • 5-ARI: 5-alpha-reductase Inhibitor
  • AUA: American Urologic Association
  • AUR: Acute Urinary Retention
  • BPH: Benign Prostatic Hyperplasia
  • IPSS: International Prostate Symptom Score
  • PDE5: Phosphodiesterase Type 5 Inhibitor

Source Citation

Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT, Wilt TJ. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol. 2023 Sep 14:101097JU0000000000003698. doi: 10.1097/JU.0000000000003698. Epub ahead of print. PMID: 37706750.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.