Article ID Journal Published Year Pages File Type
3934053 European Urology Supplements 2008 10 Pages PDF
Abstract

ContextDuring the last two decades, it has become clear that the management of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is much more than just treating symptoms.ObjectiveThis review paper gives an overview of the main factors influencing individual treatment decisions for LUTS/BPH patients.Evidence acquisitionThis paper summarizes the content of an update lecture held during a symposium on the management of LUTS/BPH at the 2008 European Association of Urology meeting. During the presentation, the current decision drivers were discussed based upon recent literature and illustrated with the results of a Web-based survey evaluating urologists’ opinions on LUTS/BPH management.Evidence synthesisThe treatment of choice depends on the severity and type of LUTS, which are nowadays believed to have a multifactorial aetiology. Consequently, treatment for LUTS/BPH should not focus merely on the prostate, but also on other organs involved in disease pathogenesis. In addition, the progressive character of LUTS/BPH is an important driver when taking treatment decisions. Patients at low risk of disease progression require a fast and sustained symptom relief with minimal treatment morbidity, while patients at high risk of progression additionally require continuous treatment delaying LUTS/BPH progression and the development of complications. Therefore, clinicians should be able to determine a patient's individual risk of progression. At present, seven baseline parameters and three dynamic variables have been identified as predictors of LUTS/BPH progression. Furthermore, as the quality of life (QoL) of both patients and their partners is severely affected by LUTS/BPH, this aspect should also be considered. Finally, treatment decisions are also influenced by existing comorbidities in the patient.ConclusionsTreatment for LUTS/BPH should aim at relieving the symptoms and especially at improving the patient's QoL with minimal treatment morbidity. Furthermore, LUTS/BPH treatment should be adapted to the patient's individual risk of disease progression.

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