© The Canadian Journal of Urology™; 21(Supplement 2); June 2014
Address correspondence to Dr. Matt T. Rosenberg, Mid
Michigan Health Centers, 214 N West Avenue, Jackson, MI
49201 USA
A practical primary care approach to lower
urinary tract symptoms caused by benign
prostatic hyperplasia (BPH-LUTS)
Matt T. Rosenberg, MD,
1
Erik S. Witt,
1
Martin Miner, MD,
2
Jack Barkin, MD
3
1
Mid Michigan Health Centers, Jackson, Michigan, USA
2
Departments of Family Medicine and Urology, Miriam Hospital, Brown University, Providence, Rhode Island, USA
3
Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ontario, Canada
ROSENBERG MT, WITT ES, MINER M, BARKIN J.
A practical primary care approach to lower
urinary tract symptoms caused by benign prostatic
hyperplasia (BPH-LUTS).
Can J Urol
2014;21(Suppl 2):
12-24.
In the primary care office the evaluation of prostate related
lower urinary tract symptoms (BPH-LUTS) in themale can
be confusing. Are the symptoms, in fact, from the prostate
or is there another etiology such as the bladder or medical
conditions causing or contributing to the problems? If the
cause is the prostate, how does the physician choose from
the multitude of available treatment options and when
is referral appropriate? The prevalence of BPH-LUTS
is high and commonly encountered by the primary care
physician (PCP). An understanding of the normal prostate
is essential to identifying the patient when symptoms do
occur. Then the evaluation and treatment of the affected
patient can occur effectively and efficiently in the PCP
setting.
In this article we present the background information
needed for the PCP to provide this evaluation of the patient
with BPH-LUTS. We explain the various treatment
options that are best suited for the individual which are
based on symptom severity, sexual dysfunction and risk
of progression. We also identify follow up parameters and
reasons for referral.
Key Words:
lower urinary tract symptoms, benign
prostatic hyperplasia, primary care approach
of the symptomatic patient into the domain of the
primary care physician (PCP). Unfortunately, the
education for the PCP in this disease state has not
entirely caught up with the advances that have been
made, which presents a definite opportunity where
the patient is the beneficiary. Understanding that
the average day of the PCP is intensely complex
a simplified approach to the prostate is essential.
This approach would help identify the patient with
symptom distress or who is asymptomatic but at risk
for progression. It would stratify treatment based
on severity of symptoms, bother, age and size of the
prostate, which are risk factors for disease progression.
Also, this approach would include how to recognize
the appropriate indications and timing for referral. In
this article we present our viewon a practical approach
to the treatment of prostate related lower urinary tract
symptoms (BPH-LUTS).
Introduction
The treatment of the symptomatic prostate has
undergone a major transformation in the last few
decades. Years ago, the only way to help the patient
with symptomatic enlargement was to offer surgical
reduction, thereby putting treatment into the hands
of the urologic surgeon. However, now we have
medications to treat the symptoms of obstruction
(alpha blockers and phosphodiesterase inhibitors)
as well as agents to shrink the gland itself (5 alpha
reductase inhibitors) thereby reserving surgical
intervention for the refractory patients or those with
disease progression. This now places the treatment
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