Page 1 - Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update

ORIGINAL RESEARCHCUA GUIDELINE

Canadian Urological Association guideline on male lower urinary tract

symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update

J. Curtis Nickel, MD ; Lorne Aaron, MD ; Jack Barkin, MD ; Dean Elterman, MD ; Mahmoud Nachabé, MD ;
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Kevin C. Zorn, MD 5
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1 Department of Urology, Queen’s University, Kingston, ON; Service d’Urologie and Centre de la Prostate, Longueuil, QC; Division of Urology, University of Toronto, Humber River Hospital, Toronto, ON;
4 Division of Urology, University of Toronto, Toronto, ON; Université de Montréal, Montreal, QC; Canada
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Cite as: Can Urol Assoc J 2018;12(10):303-12. http://dx.doi.org/10.5489/cuaj.5616 1. Diagnostic guidelines
The committee recommended minor revisions in regard
Introduction to diagnostic considerations as outlined in the 2010 CUA
BPH guideline. 1
The current document summarizes the state-of-the-art know-
ledge as it relates to management of male lower urinary tract 1.1. Mandatory
symptoms (MLUTS) secondary to benign prostatic hyper-
plasia (BPH) by updating the 2010 Canadian Urological In the initial evaluation of a man presenting with LUTS, the
Association (CUA) BPH guideline. The process continues evaluation of symptom severity and bother is essential. Medical
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to highlight the essential diagnostic and therapeutic infor- history should include relevant prior and current illnesses, as
mation in a Canadian context. The information included in well as prior surgery and trauma. Current medication, includ-
this document includes that reviewed for the 2010 guideline ing over-the-counter drugs and phytotherapeutic agents, must
and further information obtained from an updated MEDLINE be reviewed. A focused physical examination, including a digi-
search of the English language literature, as well as review tal rectal exam (DRE), is also mandatory. Urinalysis is required
of the most recent American Urological Association (AUA) 2 to rule out diagnoses other than BPH that may cause LUTS
and European Urological Association (EAU) guidelines. 3 and may require additional diagnostic tests. 1-3,5,6,7
References include those of historical importance, but man- – History
agement recommendations are based on literature published – Physical examination including DRE
between 2000 and 2017. When information and data is – Urinalysis
available from multiple sources, the most relevant (usually
most recent) article (committee opinion) is cited. 1.2. Recommended
These guidelines are directed toward the typical male
patient over 50 years of age, presenting with LUTS and Symptom inventory (should include bother assessment): A for-
an enlarged benign prostate (BPE) and/or benign prostatic mal symptom inventory (e.g., International Prostate Symptom
obstruction (BPO). It is recognized that men with LUTS asso- Score [IPSS] or AUA Symptom Index [AUA-SI]) is recom-
ciated with non-BPO causes may require more extensive mended for an objective assessment of symptoms at initial con-
diagnostic workup and different treatment considerations. tact, for followup of symptom evolution for those on watchful
In this document, we will address both diagnostic and waiting, and for evaluation of response to treatment. 8-11
treatment issues. Diagnostic guidelines are described in the PSA: Testing of prostate-specific antigen (PSA) should be
following terms as: mandatory, recommended, optional, or offered to patients who have at least a 10-year life expect-
not recommended. The recommendations for diagnostic ancy and for whom knowledge of the presence of prostate
guidelines and principles of treatment were developed on the cancer would change management, as well as those for
basis of clinical principle (widely agreed upon by Canadian whom PSA measurement may change the management
urologists) and/or expert opinion (consensus of committee of their voiding symptoms (estimate for prostate volume).
and reviewers). The grade of recommendation will not be Among patients without prostate cancer, serum PSA may
offered for diagnostic recommendations. Guidelines for also be a useful surrogate marker of prostate size and may
treatment are described using the GRADE approach for also predict risk of BPH progression. 12,13
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summarizing the evidence and making recommendations
CUAJ • October 2018 • Volume 12, Issue 10 303
© 2018 Canadian Urological Association