Clinical guideline for male lower urinary tract symptoms

Abstract

This article is a shortened version of the clinical guideline for lower urinary tract symptoms (LUTS), which has been developed in Japan for symptomatic men aged 50 years and over irrespective of presumed diagnoses. The guideline was formed on the PubMed database between 1995 and 2007 and other relevant sources. The causes of male LUTS are diverse and attributable to diseases/dysfunctions of the lower urinary tract, prostate, nervous system, and other organ systems, with benign prostatic hyperplasia, bladder dysfunction, polyuria, and their combination being most common. The mandatory assessment should comprise medical history, physical examination, urinalysis, and measurement of serum prostate-specific antigen. Symptom and quality of life questionnaires, bladder diary, residual urine measurement, urine cytology, urine culture, measurement of serum creatinine, and urinary tract ultrasonography would be optional tests. The Core Lower Urinary Tract Symptom Score Questionnaire may be useful in quickly capturing important symptoms. Severe symptoms, pain symptoms, and other clinical problems would indicate urological referral. One should be careful not to overlook underlying diseases such as infection or malignancy. The treatment should be initiated with conservative therapy and/or medicine such as a1-blockers. Treatment with anticholinergic agents should be reserved only for urologists, considering the risk of urinary retention. The present guideline should help urologists and especially non-urologists treat men with LUTS.

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia among Ghanaian men: a hospital-based cross-sectional prospective study

“…[6][7][8] Other factors, unrelated to prostatitis conditions including diet or fluid intake, alcohol intake and anticholinergic effects of commonly used medication (available without prescription) could affect the quality of life of the individual. 8,9 Clinical BPH is a term synonymous with LUTS in the presence of prostate enlargement detected on digital rectal examination (DRE). 10,11 The prevalence of LUTS differ with the demographics of a subject with BPH.…”

A critical review of recent clinical practice guidelines on the diagnosis and treatment of non-neurogenic male lower urinary tract symptoms

“…Urine cytology was considered optional in the JUA 2009, 12 CUA 2010 and UAA guidelines for patients with hematuria-suspected bladder cancer or in BPH patients not responding to medical treatment with predominant irritative LUTS. Pressure-flow studies were optional, particularly before surgery.…”

“…1). We included the following guidelines: National Institute for Health and Clinical Excellence (NICE), 9 American Urological Association (AUA), 10 European Association of Urology (EAU), 11 Japanese Urological Association (JUA) 2009 and 2011, 12,13 Urological Association of Asia (UAA), 14 Canadian Urological Association (CUA) 2010 and 2012, 15,16 International Consultation on Urological Diseases (ICUD6), 17 and British Association of Urological Surgeons (BAUS).…”

Legal claims and bias in creating clinical practice guidelines: Which step in which direction?

“…On this point, the expert panel that published clinical guideline for male lower urinary tract symptoms has to be commended as their evaluation process also comprised recommendations derived from guidelines provided by the AUA and EAU. 3 Other than being bias free, recommendations from guidelines should be timely and reliable, because litigating attorneys have recognised the critical role that CPG could play in medical malpractice litigation whenever a physician faces legal problems as a consequence of medical acts depending on emerging scientific evidence not yet included in the most recent guidelines adopted as reference. Unfortunately Homma and colleagues took into consideration relevant references published until 2007, 3 with the only chance to consider the outdated American and European guidelines printed in [2004][2005][2006].…”

“…3 Other than being bias free, recommendations from guidelines should be timely and reliable, because litigating attorneys have recognised the critical role that CPG could play in medical malpractice litigation whenever a physician faces legal problems as a consequence of medical acts depending on emerging scientific evidence not yet included in the most recent guidelines adopted as reference. Unfortunately Homma and colleagues took into consideration relevant references published until 2007, 3 with the only chance to consider the outdated American and European guidelines printed in [2004][2005][2006]. Therefore, the laudable effort lavished in merging all the existing evidence and recommendations could be partly effective as the sources of information are themselves out of date.…”