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Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.
Male patients presenting with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are commonly seen by family physicians in the community due to worldwide ageing demographics. This succinct guide serves to assist the busy physician on the clinical examination, investigations and management in a primary care setting.
Clinical BPH is prostate adenoma/adenomata (PA) causing a varying degree of bladder outlet obstruction with or without symptoms. PA comprises an important cause of male LUTS . PA is a widespread problem that increases with age. Almost one in four men with prostate problems aged 40–49 years receives treatment, and this increases to three in every four men aged 70 years and older .
Male LUTS can be classified as follows:
In general, the symptoms seen in early BPH are nocturia and slower urinary stream with sensation of incomplete voiding. When male patients present with urinary urgency and urge incontinence, the concern is that we are dealing with advanced BPH as they may have developed bladder dysfunctions.
Family physicians are usually the first medical professionals patients consult for symptoms and signs suggestive of PA. The guidelines proposed here are suggestions on how family physicians can best diagnose and treat patients with PA.
The following suggested optional tests can be performed in the family practice setting, pending logistics:
Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal PSA level, no palpable bladder and no haematuria or pyuria on the labstix.
This serves as a concise guide for the family physician and a flowchart of the management of BPH/male LUTS patients is shown in Fig. 1. We believe that by following this guideline, a significant proportion of such patients with BPH and LUTS can be managed in the community, thus ensuring a proper balance in the need for referrals to the urologist and cost effectiveness.
The authors declare no conflicts of interest.
The authors thank Ms Mei Ying Ng for her assistance in editing the manuscript.
Peer review under responsibility of Second Military Medical University.