Treatments for Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia BPHand its clinical manifestation as lower urinary tract Diagnosis Behandlung von BPH LUTSis a major health concern for aging men. There have been significant advances in the diagnosis and treatment of BPH in recent years. There has been a renewed interest in medical therapies and less invasive surgical techniques.
As a consequence, the treatment needs of men with mild to moderate LUTS without evidence of prostate cancer can now be accomplished in a primary care setting.
The essence of the model centres around educating and communicating effectively with the patient on BPH. This article provides primary care physicians with an overview of the diagnostic and management strategies outlined in recent CUA and AUA guidelines so that they may be better positioned to effectively deal with this patient population. It is now apparent that we must move away from the urologist as the first-line physician, and allow primary care physicians to accept a new role in the diagnosis and management of BPH.
As a consequence, the initial management of BPH has shifted from the urologist to the family practitioner and other primary care physicians. Recent studies have demonstrated that the initial management of BPH may vary between the urologist and the primary care physician. Wei and colleagues 7 showed that the percentage of men who pursue active treatment, as opposed to watchful waiting, was notably greater for those seen by a urologist regardless of LUTS severity.
Urologists prescribed 5-alpha-reductase inhibitors 5-ARIscombination therapy with an alpha-blocker and 5-ARI, and an anticholinergic therapy significantly more often than primary care physicians.
In contrast, men with more severe symptoms requiring urgent or emergent treatment such as surgery should be seen by a urologist. This article aims to assist physicians in the diagnosis and treatment of BPH in the primary care setting so as to: 1 facilitate access to needed care; 2 improve long-term outcomes of LUTS management and stop the progression of BPH; and 3 avoid surgical consultations in cases where primary care management is sufficient.
BPH is an enlargement of the prostate gland from the progressive hyperplasia of stromal and glandular prostatic cells, 1 and is characterized histologically by the presence Diagnosis Behandlung von BPH discrete nodules in the periurethral zone of the prostate gland.
Adapted Diagnosis Behandlung von BPH the International Journal of Clinical Practice. Adapted from the Cleveland Clinical Journal of Medicine. The primary care physician can help the patient by ruling out prostate cancer and reassuring them that BPH is not cancer or even a precursor to cancer, but rather a common, treatable disorder.
Moreover, this questionnaire provides the physician with an objective means by which to gauge how a particular patient is responding to therapy. Adapted from American Family Physician. A focused urological examination should be performed. In these cases, a urologist should be involved. If there is any concern about prostate cancer from an elevated PSA or abnormal rectal examination, referral to a urologist should be made. A histologic diagnosis is required to make the diagnosis of prostate cancer.
PSA is an established biomarker for Diagnosis Behandlung von BPH cancer but can also be used in the diagnoses of BPH and provides important information on Diagnosis Behandlung von BPH progression. PSA is a more accurate reflection of prostate volume than DRE 91624 and correlates with the risk of symptom progression. It is recommended that PSA testing begin at the age of A treatment algorithm for BPH has been established by the Canadian Urological Association CUA and is based primarily on a combination of the degree of symptoms, the amount of bother, and the size of the prostate with PSA used as a surrogate marker for prostate size in patients with no clinical evidence of prostate cancer.
Watchful waiting is a management strategy whereby the patient is monitored by their physician but receives no treatment. Second-generation doxazosin and terazosin and third-generation alfuzosin and tamsulosin alpha-blockers have been recommended by the CUA as treatment options for patients with LUTS secondary Diagnosis Behandlung von BPH BPH.
The 5-ARIs, dutasteride and finasteride, act by blocking the conversion of testosterone to dihydrotestosterone DHTan androgen believed to be responsible for prostate enlargement.
If the patient has been taking the drug Diagnosis Behandlung von BPH prescribed, a referral should be made to a urologist. Treatment with both a 5-ARI and an alpha-blocker has been recommended for patients who have an enlarged prostate gland and who have symptoms of bladder outlet obstruction. Potential advantages of discontinuing the alpha-blocker include lower cost, fewer side effects and better compliance.
Therefore, if the patient is doing well on combination therapy, a trial of alpha-blocker discontinuation may be worthwhile. Phytochemicals — plant-derived, non-nutritive compounds with protective or disease-preventive properties — have been the subject of increasing interest in the treatment of BPH. However, results have been mixed, and the majority of studies involving phytochemicals have not been subjected to the same rigorous pre-clinical pharmacological testing Diagnosis Behandlung von BPH large-scale clinical trials conducted with the alpha-blockers and 5-ARIs.
The best described and studied phytotherapeutic agent, Serenoa repens saw palmettohas shown mild to moderate efficacy in reducing nocturia, increasing maximal urinary flow and improving International Prostate Symptom Score IPSS in men with BPH, 4041 with results comparable with that of tamsolusin.
Pygeum africanuman extract from the African prune tree, is another popular Diagnosis Behandlung von BPH remedy for BPH, 46 and has been shown in a Cochrane review to provide moderate relief from the urinary problems Diagnosis Behandlung von BPH by BPH. Surgical treatment of BPH is necessary, and referral to a urologist is warranted 4 if medical treatments fail, or if benign prostatic obstruction causes renal insufficiency, urinary retention, recurrent urinary tract infections, bladder calculi or hydronephrosis.
Patient evaluation, including DRE and careful differential diagnosis are important steps in making an accurate clinical diagnosis and can be easily accomplished in a primary care setting without the need for a urologist. Some tips from the authors are provided in Appendix II.
Some men with BPH are asymptomatic and others are not bothered by their symptoms; watchful waiting is most appropriate.
In addition, combination therapy, an alpha-blocker and 5-ARI, has showed a rapid improvement in symptoms with Diagnosis Behandlung von BPH side effects.
In addition, the 5-ARIs have demonstrated they can prevent progression and the need for surgery. Surgical intervention is required if and when BPH leads to other serious complications, including AUR and Diagnosis Behandlung von BPH insufficiency.
Primary care physicians can play a vital role in diagnosing and treating men with mild to moderate LUTS and no evidence of prostate cancer. Primary care physicians should use their clinical judgement when considering if and when a referral to a urologist is warranted. Total score: 0—7 Mildly symptomatic; 8—19 moderately symptomatic; 20—35 severely symptomatic. Prostate size is important in determining the risk of progression and need for therapy.
However, prostate size is difficult for primary care physicians and urologists alike to measure. This information allows them to objectively assess the action of the 5-ARI, even from 3 months onward. Reduced ejaculation can be used as a marker to demonstrate to men that the 5-ARI Diagnosis Behandlung von BPH working. The Diagnosis Behandlung von BPH should be informed that this change in volume should not reduce sexual pleasure and is reversible.
Patients should understand that stopping their prostate growth is important in preventing the likelihood of needing a surgical intervention and bleeding down the road. Although only a minority of men will ever really need to have a TURP or will have significant bleeding, taking the 5-ARI reduces this risk significantly and is valued by many men as a result. If a patient is doing well on combination therapy, consideration for a trial of alpha-blocker discontinuation is worthwhile.
Inform patients that 5-ARI therapy for most men is a lifelong treatment and that the use of a 5-ARI is like preventative care rather than treatment of an urgent or emergent problem. It is always better to prevent something than to fix a problem in a rush.
Men may be told that their hair may become a bit thicker as a side effect of Diagnosis Behandlung von BPH 5-ARI treatment. This article has been peer reviewed. Competing interests: None declared. National Center for Diagnosis Behandlung von BPH InformationU. Can Urol Assoc J. Curtis Nickel. Author information Copyright and License information Disclaimer. Correspondence: Dr. This article has been cited by other articles in PMC.
Abstract Benign prostatic hyperplasia BPHand its clinical manifestation as lower Diagnosis Behandlung von BPH tract symptoms LUTSis a major health concern for aging men. Introduction Benign prostatic hyperplasia BPHand its clinical manifestation as lower urinary tract symptoms LUTSis a major health concern for aging men. Biology of BPH BPH is an enlargement of the prostate gland from the progressive hyperplasia of stromal and glandular prostatic cells, 1 and is characterized histologically by the presence of discrete nodules in the periurethral zone of the prostate gland.
Table 1. Differential diagnosis of lower urinary tract symptoms. Open in a separate window. Table 2. Lower urinary tract symptoms seen in benign prostatic hyperplasia.
Medications that may contribute to lower urinary tract Diagnosis Behandlung von BPH. Medication Mechanism Antihistamines Decreased parasympathetic tone Decongestants Increased sphincter tone via alpha-adrenergic receptor stimulation Diuretics Increased urine production Opiates Impaired bladder contractility Tricyclic antidepressants Anticholinergic effects. Physical examination A focused urological examination should be performed.
Treatment A treatment algorithm for BPH has been established by the Canadian Urological Association CUA and is based primarily on a combination of the degree of symptoms, the amount of bother, and the size of the prostate with PSA used as a surrogate marker for prostate size in patients with no clinical evidence of prostate cancer. Common drugs used to treat benign prostatic hyperplasia.
Alpha-blockers Second-generation doxazosin Diagnosis Behandlung von BPH terazosin and third-generation alfuzosin and tamsulosin alpha-blockers have been recommended by the CUA as treatment options for patients with LUTS secondary to BPH. Combination therapy Treatment with both a 5-ARI Diagnosis Behandlung von BPH an alpha-blocker has been recommended for patients who have an enlarged prostate gland and who have symptoms of bladder outlet obstruction. Phytochemicals Phytochemicals — plant-derived, non-nutritive compounds with protective or disease-preventive properties — have been the subject of increasing interest in the treatment of BPH.
BPH-related surgery Surgical treatment of BPH is necessary, and referral to a urologist is warranted 4 if medical treatments fail, or if benign prostatic obstruction causes renal insufficiency, urinary retention, recurrent urinary tract infections, bladder calculi or hydronephrosis.
Not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always Your score Nocturia Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?
Quality of life due to urinary symptoms Delighted Pleased Mostly satisfied Mixed — about equally satisfied and dissatisfied Mostly dissatisfied Unhappy Terrible If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?
Appendix II. Tips for managing benign prostatic hyperplasia in the primary care setting Diagnosis Behandlung von BPH size is Diagnosis Behandlung von BPH in determining the risk of progression and need for therapy. Alpha-blockers work quickly but do not decrease the risk of progression. Combination therapy works better than monotherapy. Footnotes This article has been peer reviewed.
References 1. Nickel JC. The overlapping lower Diagnosis Behandlung von BPH tract symptoms of benign prostatic hyperplasia and prostatitis.
Curr Opin Urol. Managing enlarged prostate in primary care. Int J Clin Pract. Miner M. Can J Urol.