Aafp bph

Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone, aafp bph.

Benign prostatic hyperplasia BPH is the most common cause of lower urinary tract symptoms in men. This article provides a review of the available patient-oriented evidence to evaluate and manage lower urinary tract symptoms from BPH. Lower urinary tract symptoms from BPH affect Risk factors for BPH are listed in Table 1. Potential causes of lower urinary tract symptoms are identified with patient factors. Important family history can include urethral, bladder, prostatic, or urothelial cancer. Having multiple sex partners increases risk of prostatitis.

Aafp bph

Symptomatic benign prostatic hyperplasia BPH may affect up to 30 percent of men in their early 70s, causing urinary symptoms of bladder outlet obstruction. Symptoms can improve without treatment, but the usual course is a slow progression of symptoms, with acute urinary retention occurring in 1 to 2 percent of men with BPH per year. Alpha blockers improve symptoms compared with placebo and more rapidly than with finasteride, and may be most effective in men with more severe symptoms of BPH or with hypertension. Caution : A drug safety alert has been issued on the risk of intraoperative floppy iris syndrome during cataract surgery with tamsulosin and probably with other alpha blockers. Persons taking an alpha blocker should inform their eye surgeon. Caution : A drug safety alert has been issued on the risk of male breast cancer with finasteride. Changes in breast tissue such as lumps, pain, or nipple discharge should be promptly reported for further assessment. Saw palmetto plant extracts may be no more effective than placebo at improving symptoms. However, evidence was weak, and further good-quality long-term randomized controlled trials are needed. We do not know whether rye grass pollen extract and Pygeum africanum are also beneficial, as few studies were found. Transurethral resection of the prostate TURP improves symptoms of BPH more than watchful waiting, and has been shown not to increase the risk of erectile dysfunction or incontinence. Some less invasive surgical techniques such as transurethral incision, laser ablation, transurethral holmium laser enucleation, and transurethral electrovaporization seem to be as effective as TURP at improving symptoms. TURP may be more effective at improving symptoms and preventing retreatment compared with transurethral microwave thermotherapy, but causes more complications.

However, a more recent Canadian study 29 showed increasing use of the less invasive surgical procedures.

Because of the aging of the U. Recent studies have shown that more than 80 percent of men older than 80 years have BPH. The diagnosis of this condition is presumptive based on the patient's symptoms. These symptoms include urinary frequency, nocturia, urgency, hesitancy, weak or intermittent urine stream, straining to void, and sensation of incomplete voiding. It is common for an enlarged prostate to be found on rectal examination, but enlargement is not necessary for the diagnosis of BPH, in that palpable prostate size does not correlate with the degree of obstruction or the severity of symptoms. Although the symptoms of BPH vary from patient to patient and can be difficult to grade, they are key to the diagnosis and treatment of this condition. Instead of using traditional BPH terminology, some physicians may refer to these symptoms as lower urinary tract symptoms.

Federal government websites often end in. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf. Michael Ng ; Stephen W. Leslie ; Krishna M. Authors Michael Ng 1 ; Stephen W.

Aafp bph

Benign prostatic hyperplasia BPH is the most common cause of lower urinary tract symptoms in men. This article provides a review of the available patient-oriented evidence to evaluate and manage lower urinary tract symptoms from BPH. Lower urinary tract symptoms from BPH affect Risk factors for BPH are listed in Table 1. Potential causes of lower urinary tract symptoms are identified with patient factors. Important family history can include urethral, bladder, prostatic, or urothelial cancer. Having multiple sex partners increases risk of prostatitis. The differential diagnosis for lower urinary tract symptoms is summarized in Table 2. Voiding symptoms include urinary hesitancy, delay in initiating, intermittency, weak urinary stream, and dysuria. Storage symptoms include urinary frequency, nocturia, urgency, enuresis, and incontinence.

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Treatment with finasteride preserves usefulness of prostate-specific antigen in the detection of prostate cancer: results of a randomized, double-blind, placebo-controlled clinical trial. All patients with suspected BPH should undergo dipstick urinalysis testing or microscopic urinalysis to screen for infection or hematuria, and a serum creatinine determination to evaluate renal function. Scientists are still investigating whether this is safe and effective. Urinalysis should be ordered to look for glucosuria, proteinuria, hematuria, and evidence of infection, with urine culture if necessary. The availability and use of these newer procedures vary regionally. Long-term complications include retrograde ejaculation 70 percent of treated patients , impotence 14 percent; range: 3 to 32 percent , partial incontinence 6 percent , and total incontinence 1 percent. Scientists have found that even when testosterone levels fall, DHT levels can remain high. In the past, transurethral balloon dilation of the prostate was used as a safe, minimally invasive treatment for BPH. Robust data with proven long-term outcomes Bipolar TURP reduces risk of hyponatremia and transurethral resection syndrome. Eur Urol. Symptomatic improvement occurs in 98 percent of patients who undergo this procedure, and the retreatment rate is only 2 percent.

Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. Benign prostatic hyperplasia, or BPH, causes your prostate gland to get bigger.

Having multiple sex partners increases risk of prostatitis. Another minimally invasive procedure is ablation of the prostate by electrode or laser. Physical examination should include a digital rectal examination and assessment for bladder distention or neurologic impairment. More in AFP. Alpha blockers are effective for bothersome, moderate to severe BPH and are recommended in men not undergoing planned cataract surgery. Hypertension Hypertension is associated with more lower urinary tract symptoms and larger prostate volumes and may decrease the effectiveness of treatment with alpha blockers. Several minimally invasive surgical therapies have fewer adverse effects than TURP, but many lack high-quality data or have higher retreatment rates. Behavioral techniques can be used to reduce your symptoms. However, anyone who experiences urinary problems should see a doctor. Outpatient procedure Shorter catheterization time Good for patients on anticoagulation or for nonsurgical candidate Less bleeding. Transrectal ultrasound-guided ablation of prostatic tissue using targeted high-velocity saline stream followed by electrocautery hemostasis. If cataract surgery is being considered, avoid alpha blockers until ophthalmologist evaluation because of associated floppy iris syndrome.