Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia

The present article is the abbreviated English translation of the Japanese guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia updated as of the end of 2016. The target patients are men aged >50 years complaining of lower urinary tract symptoms, with or without benign prostatic hyperplasia, and the target readers are non-urological general physicians and urologists. Mandatory assessment for general physicians is medical history, physical examination, urinalysis and measurement of serum prostate-specific antigen. Additional mandatory assessment for urologists is symptoms and quality of life assessment by questionnaires, uroflowmetry, residual urine measurement, and prostate ultrasonography. Nocturia requires special attention, as it can result from nocturnal polyuria and/or sleep disturbance rather than lower urinary tract disorders. Functional lower urinary tract disorders with or without benign prostatic hyperplasia are primarily managed by conservative therapy and medications, such as α1 -blockers and phosphodiesterase-type 5 inhibitors. Use of other medications or combination pharmacotherapy is to be reserved for urologists. 5α-Reductase inhibitors and anticholinergics or β3 agonists are indicated for men with enlarged prostates and overactive bladder symptoms, respectively. Surgical intervention for bladder outlet obstruction is considered for persistent symptoms or benign prostatic hyperplasia-related comorbidities. Surgical modalities should be optimized by the patient's characteristics, performance of equipment and the surgeon's experience.

International journal of urology : official journal of the Japanese Urological Association. 2017 Jul 26 [Epub ahead of print]

Yukio Homma, Momokazu Gotoh, Akihiro Kawauchi, Yoshiyuki Kojima, Naoya Masumori, Atsushi Nagai, Tadanori Saitoh, Hideki Sakai, Satoru Takahashi, Osamu Ukimura, Tomonori Yamanishi, Osamu Yokoyama, Masaki Yoshida, Kenji Maeda

Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan., Department of Urology, Shiga Medical University, Shiga, Japan., Department of Urology, Fukushima Prefectural University of Medicine, Fukushima, Japan., Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan., Department of Urology, Kawasaki Medical School, Kurashiki, Japan., Department of Urology, Sanikukai Hospital, Tokyo, Japan., Department of Urology, Nagasaki University, Nagasaki, Japan., Department of Urology, Nihon University, Tokyo, Japan., Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan., Department of Urology, Dokkyo Medical University, Tochigi, Japan., Department of Urology, University of Fukui, Fukui, Japan., Department of Urology, National Center of Geriatrics and Gerontology, Obu, Japan., Department of Urology, Maeda Clinic of Internal Medicine, Ageo, Japan.