This Clinical Practice Guideline makes specific recommendations to identify both the most effective methods for diagnosing benign prostatic hyperplasia (BPH) and the most appropriate treatments for BPH based on patient preference and clinical need.

The most important risk factors for the development of BPH are poorly understood. This guideline represents the most current scientific knowledge regarding its development, diagnosis, and treatment.

Guideline recommendations target two overall goals: (1) identifying the most appropriate and effective diagnostic methods for detecting BPH and gauging its severity and (2) selecting the most appropriate treatment approach. BPH is a disease that affects a patient's quality of life. The guideline emphasizes that since BPH is very rarely a life-threatening disease, many patients may choose a regimen of "watchful waiting" rather than more active treatments. This is an appropriate choice for many patients. Motivation to seek active treatment will, for most patients, depend on the degree to which their symptoms bother them. The guideline details the relative benefits and harms associated with all diagnostic and treatment approaches, including watchful waiting.

Discussed in the guideline are both invasive and noninvasive diagnostic methods: recommended, optional, and not recommended for BPH. Treatment options include watchful waiting, alpha blocker and finasteride medications, balloon dilation, and surgical options: transurethral incision, transurethral resection, and open prostatectomy. Among the still investigational methods for treating BPH are laser prostatectomy, thermal therapy, and other emerging modalities.

Contents

• Guideline Development and Use
• [Forward]
• Dedication
• Panel Members
• Acknowledgments
• Executive Summary
• 1. Overview
  • Purpose and Scope
  • Background
  • Methodology for Guideline Development
• 2. BPH Diagnosis Summary
  • Guideline Applicability
  • Initial Evaluation
  • Symptom Assessment
  • Optional Tests
  • Tests Not Recommended
• 3. Initial Evaluation
  • Medical History
  • Physical Examination
  • Urinalysis
  • Creatinine Measurement (Assessment of Renal Function)
  • Prostate-Specific Antigen
• 4. Symptom Assessment
• 5. Optional Diagnostic Tests
  • Optional Tests in Men with a Guideline for BPH Surgery
  • Uroflowmetry
  • Postvoid Residual Urine
  • Pressure-Flow Studies
• 6. Tests Not Recommended
  • Filling Cystometry (Cystometrography or CMG)
  • Urethrocystoscopy
  • Imaging of the Urinary Tract
• 7. BPH Treatment Summary
  • Treatment Options Reviewed
  • Treatment Recommendations
  • Panel Review of Treatment Outcomes
  • Panel Analysis of Benefits and Harms
• 8. Indirect Treatment Outcomes
  • Peak Urinary Flowrate (Q[max])
  • Postvoid Residual Urine
  • Conclusions
• 9. Direct Treatment Outcomes— Symptom Improvement
  • Probability of Symptom Improvement
  • Magnitude of Symptom Improvement
  • Conclusions
• 10. Direct Treatment Outcomes— Complications
  • Complications from Treatment with Drugs
  • Surgical Morbidity
• 11. Direct Treatment Outcomes— Sexual Dysfunction
  • Prevalence of Impotence
  • BPH Surgery-Related Impotence
  • Impotence from Drug Treatment
  • Retrograde Ejaculation After BPH Treatment
• 12. Direct Treatment Outcomes— Urinary Incontinence
  • Stress Urinary Incontinence
  • Urge Urinary Incontinence
  • Total Urinary Incontinence
  • Treatment Comparisons
• 13. Direct Treatment Outcomes— Late Complications
  • Urethral Stricture After Open Surgery
  • Urethral Stricture After TUIP
  • Urethral Stricture After TURP
  • BNC After Open Surgery
  • BNC After TUIP
  • BNC After TURP
  • Conclusions
• 14. Direct Treatment Outcomes— Need for Retreatment
  • Overview
  • Factors Influencing Reported Rates
  • Treatment Modalities
• 15. Direct Treatment Outcomes— Mortality
  • Perioperative Mortality
  • Delayed Mortality
• 16. Cost of Treatment
• 17. Hospital Stay, Recovery Time, Loss of Work Time
  • Hospital Stay
  • Loss of Work Time
• 18. Treatment Preference Analysis
  • Proxy Judge Analysis
  • Patient Preference Analysis
  • Conclusions
• 19. Investigational Treatment Strategies
  • Evaluation of New Technologies
  • New Medical Therapies
• 20. Future Research Needs
  • Natural History and Epidemiology
  • Diagnosis and Initial Management
  • Treatment
  • Quality of Life
  • Economics
• Acronyms and Abbreviations
• Glossary
• Contributors
• Attachments
• References

Suggested citation:

McConnell JD, Barry MJ, Bruskewitz RC, et al. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guideline, Number 8. AHCPR Publication No. 94-0582. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. February 1994.