Diagnosis and management of benign prostatic hyperplasia in primary care

Abstract

S92colleagues 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. 4 Urologists and primary care physicians also differed in their choice of therapy. Urologists prescribed 5-alpha-reductase inhibitors (5-ARIs), combination therapy with an alpha-blocker and 5-ARI, and an anticholinergic therapy significantly more often than primary care physicians. 4 Primary care physicians, on the other hand, prescribed nonselective alpha-blockers more often than urologists. 4 It is not apparent why these differences exist, but it is possible that primary care physicians view LUTS mostly as a quality of life (QOL) issue and are less concerned with the progressive nature of the disease. 4 It could also be due to the fact that patients with similar symptoms but who are more bothered about them are referred along to a urology specialist for management. That being said, many feel that a "shared care" approach to the diagnosis and treatment of BPH should be adopted. 3,8 Primary care physicians are better positioned to identify men with LUTS and those at risk for disease progression, and should consider treatment for those men with mild to moderate symptoms without evidence of prostate cancer. In contrast, men with more severe symptoms requiring urgent or emergent treatment (such as surgery) should be seen by a urologist.3 Thus, educating primary care physicians regarding changes in the management of BPH and progression is very important. 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. Diagnosis and management of benign prostatic hyperplasia in primary care REVIEW AbstractBenign prostatic hyperplasia (BPH), and its clinical manifestation as lower urinary tract symptoms (LUTS), is 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. There are differences in the way urologists and primary care physicians approach the evaluation and management of LUTS due to BPH, which is not reflected in Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines. A "shared care" approach involving urologists and primary care physicians represents a reasonable and viable model for the care of men suffering from LUTS. 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 m...

Mitochondria-dependent apoptogenic activity of the aqueous root extract of Croton membranaceus against human BPH-1 cells

“…Approximately 42% of men aged 51-60 years, 70% of men aged 61-70 years, and almost 90% of men aged 81-90 years have BPH (Tanguay et al, 2009). Enlargement of the prostate often results in lower urinary tract symptoms, which have a negative impact on the quality of life of patients (Kramer et al, 2007).…”

Outcomes and general health-related quality of life among patients medically treated in general daily practice for lower urinary tract symptoms due to benign prostatic hyperplasia

“…Inadequate management of LUTS can trigger disease progression and lead to several complications [7]. As a consequence, patient treatment satisfaction and HRQOL assessment seem to be essential criteria to ensure optimal treatment outcomes [8, 9], particularly in French general practice where around nine out of ten prescriptions for LUTS are filled [10]. …”

The aging male population and medical care for benign prostatic hyperplasia in Canada

“…However, even under a model where the number of urologists expands to 634, this only represents an increase of 8.6% over the 2007 figure of 584 urologists, whereas a 36.8% increase would be needed simply to maintain the patients to urologist ratio that existed in 2005, a level that was already stretching the system. 7 Since 255 (43.7%) of the 584 urologists in practice in 2007 graduated with their MD degrees more than 25 years earlier, an increase in the number of urologists in the next 10 years seems highly unlikely. Moreover, young physicians tend to seek greater balance between professional and non-professional activities, which implies working less hours than physicians have in the past.…”

“…Although pharmacologic therapy has become first-line treatment for BPH and moved responsibility for the initial management of BPH into the primary care setting, 7,10 it is reasonable to assume that urologists will retain their role in the treatment of msLUTS, although new surgical technologies that can be used in the outpatient setting may enable them to treat more patients. 11,12 Another assumption is that the treatment of BPH/LUTS will remain the same over the next 10 years.…”