Benign Prostatic Hyperplasia (American College of Physicians PIER)
The mean age at development of symptomatic benign prostatic hyperplasia (BPH) is about 60, and 17% of U.S. men age 50 to 59 have symptoms attributable to BPH. Consider BPH in men with the following obstructive and irritative lower urinary tract symptoms: decreased caliber and force of urinary stream, hesitancy in initiating voiding, postvoid dribbling, sensation of incomplete emptying, frequency, urgency, nocturia, urinary retention, and incontinence.
In addition to screening (begin asking men in their 50s about prostate-related symptoms) this activity addresses diagnosis (include history, physical exam -- with digital rectal exam -- urinalysis and serum creatinine concentration); consultation for diagnosis; hospitalization (patients who have urinary retention and evidence of acute renal insufficiency); non-drug therapy (conservative measures when mild or moderate symptoms); drug therapy (alpha-1 blockers and 5-alpha-reductase inhibitors); patient education; consultation for management; and follow-up.
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