From Medscape Medical News
Emma Hitt, PhD
February 7, 2011 — The American Urological Association (AUA) has issued updated guidance on the treatment of benign prostatic hyperplasia (BPH).
The newly released guidelines update current recommendations, first published in 2003, for diagnosing and treating this disorder. The guidelines were released online February 3 and will be published in an upcoming print issue of the Journal of Urology.
The updated guidelines include a detailed diagnostic algorithm to guide physicians in diagnosing and treating lower urinary tract symptoms (LUTS) that result from BPH. They also provide in-depth information on BPH management strategies in general and on complicated cases in particular.
"Physicians treating men with suspected cases of LUTS should obtain a relevant medical history, assess symptoms using the AUA Symptom Index and conduct a full physical examination (including a digital rectal exam)," states a written release from the AUA. "Laboratory tests should include a prostate-specific antigen...test and a urinalysis to exclude infection or other causes for LUTS," and "frequency and volume charts may also be useful in providing a diagnosis."
The guidelines maintain that some patients may benefit using a combination of all 3 modalities. "Should improvement be insufficient and symptoms severe, then newer modalities of treatment such as botulinum toxin and sacral neuromodulation can be considered," the report states.
According to the AUA, the 2003 update provided key information on the use of surgical and medical approaches, whereas the 2010 updated version contains added recommendations for the use of anticholinergic drugs and the use of laser therapies. In addition, the index patient age has been lowered from 50 years to 45 years to improve guidance for the treatment of younger men with LUTS.
The guidelines also advise clinicians to remain vigilant about intraoperative floppy iris syndrome in patients with cataract who are taking alpha-blockers to treat BPH. Patients should be asked about any planned cataract surgery before starting an alpha-blocker regimen, and if surgery is planned, alpha-blockers should be avoided until after the procedure.
The panel also recommends against the routine measurement of serum creatinine levels in the initial evaluation of men with LUTS secondary to BPH.
The clinical guideline was developed after panelists had conducted a systematic review and had synthesized the clinical literature on current and emerging therapies for the treatment of BPH.
The panelists asked 3 questions regarding current therapy for BPH: "(1) What is the comparative efficacy...and effectiveness...of currently available and emerging treatments for BPH? What are the predictors of beneficial effects from treatments? (2) What are the adverse events associated with each of the included treatments, and how do the adverse events compare across treatments? (3) Are there subpopulations in which the efficacy, effectiveness, and adverse event rates vary from those in general populations?"
"The methodology followed the same process used in the development of the 2003 Guideline and, as such, did not include an evaluation of the strength of the body of evidence as will be instituted in future Guidelines produced by the AUA," the report states.
In a news release, chair of the guideline's panel Kevin T. McVary, MD, noted, "The increasing life expectancy and growth of our elderly population will increase the number of men who suffer from LUTS.
"This will place increased demands for treatment services, and necessitate the incorporation of evidence-based medicine" and "provides much-needed guidance to doctors who are already treating LUTS."
The report was compiled without commercial support.
AUA. Published online February 3, 2011.
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