Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia

Abstract

The present article is the abbreviated English translation of the Japanese guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia updated as of the end of 2016. The target patients are men aged >50 years complaining of lower urinary tract symptoms, with or without benign prostatic hyperplasia, and the target readers are non-urological general physicians and urologists. Mandatory assessment for general physicians is medical history, physical examination, urinalysis and measurement of serum prostate-specific antigen. Additional mandatory assessment for urologists is symptoms and quality of life assessment by questionnaires, uroflowmetry, residual urine measurement, and prostate ultrasonography. Nocturia requires special attention, as it can result from nocturnal polyuria and/or sleep disturbance rather than lower urinary tract disorders. Functional lower urinary tract disorders with or without benign prostatic hyperplasia are primarily managed by conservative therapy and medications, such as a 1 -blockers and phosphodiesterase-type 5 inhibitors. Use of other medications or combination pharmacotherapy is to be reserved for urologists. 5a-Reductase inhibitors and anticholinergics or b3 agonists are indicated for men with enlarged prostates and overactive bladder symptoms, respectively. Surgical intervention for bladder outlet obstruction is considered for persistent symptoms or benign prostatic hyperplasia-related comorbidities. Surgical modalities should be optimized by the patient's characteristics, performance of equipment and the surgeon's experience.

Superiority of dutasteride 0.5 mg and tamsulosin 0.2 mg for the treatment of moderate‐to‐severe benign prostatic hyperplasia in Asian men

“…The observed safety and tolerability profile of combination therapy was consistent with the known safety profiles for the individual monotherapies. In accordance with the Japanese and Korean guideline grade A recommendations, the present study provides evidence to support the use of dutasteride 0.5 mg + tamsulosin 0.2 mg combination as an effective treatment option to provide symptom improvement and reduce the long‐term risk of BPH progression …”

Comparison of the clinical effect of dutasteride therapy for benign prostatic hyperplasia when initiated at different time points: A multicentre, observational, retrospective chart review study

“…The symptoms of BPH are known to substantially impair the quality of life for patients . Importantly, patients who visit their clinician because of LUTS may already have moderate‐to‐severe symptoms and, as such, are at an increased risk of further disease progression …”

Prostate Basal Cell Carcinoma: A Case Report

“…4). The patient’s chief complaints were lower urinary tract symptoms, gross hematuria, and a hard prostate nodule [8, 12]. PBCC was incidentally diagnosed using specimens from TUR-P, which had been performed for his lower urinary tract symptoms.…”