Classifying them into storage and voiding symptoms is helpful for the choice of drug therapy. Particularly in men over the age of 50, micturition-related symptoms should be specifically addressed in the general medical history. If either the patient history or the clinical presentation suggests the possibility of renal dysfunction, or if surgery is being considered, renal function should be assessed by determining the serum creatinine concentration and glomerular filtration rate ( 1, 9). Although the usefulness of routine urinalysis in patients with micturition-related symptoms has been questioned, both the current guideline of the European Association of Urology (EAU) on the management of LUTS ( 1) and the current recommendations of the National Institute of Health and Care Excellence (NICE) ( 9) support it. The dipstick test usually provides semiquantitative information on the presence of any urinary tract infection, proteinuria, hematuria, and glycosuria. Symptomatic BPH is therefore regarded as one of the most common disorders in men and, because it is widespread, one that has significant socioeconomic impact.įor every patient with BPH a urinalysis should also be performed. On average, 50% of men over 60 and 80% of men over 80 have symptoms caused by BPH. How would you feel if your current symptoms around urination did not change in the future? On average, how often did you get up to urinate during the night (i.e., between going to bed and getting up in the morning)? How often did you need to make an effort or strain to start urinating? How often have you had a weak stream when urinating? How often have you had difficulty delaying urination? How often have you had to stop and start again several times over while urinating (urinary hesitancy)? How many times did you have to urinate a second time within 2 hours? How often did you have the feeling that your bladder was not completely empty after urinating? Special questionnaires are used for the patient history the most commonly used is the International Prostate Symptom Score (IPSS) questionnaire (also available in German) ( table 1) ( 2). Flow chart for recommendation medical management of patients with possibly BPH-related symptoms, based on the guidelines of the European Society of Urology ( 1)īPH, benign prostatic hyperplasia DRE, digital rectal examination HoLEP, holmium laser enucleation of the prostate ICIQ, International Consultation on Incontinence Questionnaire IIEF, International Index of Erectile Function IPSS, International Prostate Symptom Score PSA, prostate-specific antigen PVR, postvoid residual urine TUIP, transurethral incision of the prostate ThuLEP, thulium laser enucleation TURP, bipolar transurethral prostateresectionĪfter the initial urological referral, the specific tests outlined below are carried out to determine the severity of the disease and whether active treatment is required.
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