New BPH guideline outlines diagnostic workup protocol


A detailed diagnostic algorithm and a lowering of the index patient age are among the additions to the AUA's updated clinical guideline on the treatment of BPH.

A detailed diagnostic algorithm and a lowering of the index patient age are among the additions to the AUA’s updated clinical guideline on the treatment of BPH.

The update to the guideline includes a detailed diagnostic algorithm to guide physicians in diagnosing and treating lower urinary tract symptoms secondary to BPH, as well as in-depth information on its basic management and the management of complicated cases.

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, according to the guideline. Laboratory tests should include a PSA test and a urinalysis to exclude infection or other causes for LUTS. Frequency and volume charts may also be useful in providing a diagnosis.

The update contains added recommendations for the use of anticholinergic drugs and the use of laser therapies. Additionally, the index patient age has been lowered to 45 from 50 years of age to better guide physicians in treating younger men who may be experiencing LUTS.

The guideline also includes cautionary statements about intraoperative floppy iris syndrome in cataract patients taking alpha-blockers to treat BPH. The AUA cautions physicians to question patients about any planned cataract surgery prior to their starting an alpha-blocker regimen.

"The increasing life expectancy and growth of our elderly population will increase the number of men who suffer from LUTS," said Kevin T. McVary, MD, chair of the panel that developed the guideline. "This will place increased demands for treatment services, and necessitate the incorporation of evidence-based medicine in that treatment. This document provides much-needed guidance to doctors who are already treating LUTS, as well as those who will be in the future."

The full guideline is expected to be published in an upcoming issue of the Journal of Urology. A webinar about the guideline will also be made available at the AUA’s Web site,

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