Evaluation and Medical Management of Benign Prostatic Hyperplasia

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Evaluation and Medical Management of Benign Prostatic Hyperplasia Thomas J. Beckman, MD, Lance A. Mynderse, MD Mayo Clinic Proceedings Volume 80, Issue 10, Pages 1356-1362 (October 2005) DOI: 10.4065/80.10.1356 Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Treatment algorithm for benign prostatic hyperplasia (BPH) shows treatment decisions based partly on patient symptom severity as determined by the American Urological Association Symptom Score. AUA = American Urological Association; DRE = digital rectal examination; IPSS = International Prostate Symptom Score; PE = physical examination; PSA = prostate-specific antigen; PVR = postvoid residual urine; UTI = urinary tract infection. *In patients with clinically significant prostatic bleeding, a course of a 5α-reductase inhibitor may be used. If bleeding persists, tissue-ablative surgery is indicated. †Patients with at least a 10-year life expectancy for whom knowledge of the presence of prostate cancer would change management or patients for whom the PSA measurement may change the management of voiding symptoms. ‡After exhausting other therapeutic options as discussed in detail in the text. §Some diagnostic tests are used in predicting response to therapy. Pressure-flow studies are most useful in men before surgery. From J Urol,12 with permission. Mayo Clinic Proceedings 2005 80, 1356-1362DOI: (10.4065/80.10.1356) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Uroflow tracing (top) from a young asymptomatic man. Note the parabolic flow curve and peak urinary flow rate of greater than 15 mL/s. This patient had 9 mL of residual urine on ultra-sonography. Uroflow tracing (bottom) from an elderly man with benign prostatic hyperplasia. Note the prolonged voiding time and peak urinary flow rate of less than 10 mL/s. This patient had 100 mL of residual urine on ultrasonography. Mayo Clinic Proceedings 2005 80, 1356-1362DOI: (10.4065/80.10.1356) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions