Benign prostatic hyperplasia: an approach for the internist
CRAIG D. ZIPPE, MDAddress reprint requests to C.D.Z., Department of Urology, A100, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
In benign prostatic hyperplasia, urodynamic testing and the many available drugs and surgical procedures have complicated the issue of what to do for whom. Although the severity of a patient's symptoms and his informed preferences should be the driving forces, specialized tests can help tailor treatment to the individual patient.KEY POINTS
The American Urological Association symptom index, which is derived from a short questionnaire, should be the primary determinant of treatment.
Patients with mild symptoms need reassurance and yearly follow-up, but no medical or surgical treatment.
I recommend baseline urodynamic testing for patients with moderate symptoms. Those with no signs of bladder decompensation can receive medical therapy; if there are signs of bladder decompensation, surgery is offered.
The first-line medical therapy most commonly used is an alpha adrenergic blocking agent (either terazosin or doxazosin) in titrated doses. Surgery is offered if the symptoms do not abate with maximal medical therapy.
Patients with severe symptoms usually need one of the more aggressive surgical procedures.