Benign prostatic hyperplasia guideline includes new diagnostic algorithm, lower index age

Linthicum, MD-A detailed diagnostic algorithm and a lowering of the index patient age are among additions to the AUA's updated clinical guideline on the diagnosis and treatment of BPH.

"The growing size of our older population is creating increased demand for medical services for BPH, and the 2010 guideline was developed for a broad audience that includes primary care practitioners in addition to urologists," Kevin T. McVary, MD, chair of the multidisciplinary panel that developed the BPH guideline, told Urology Times.

The guideline formally adopted a previously published workup schema (J Urol 2009; 181:1779-87). Although it is consistent with the 2003 guideline's algorithm for diagnosis and treatment, the new flowchart's recommendations aim to streamline therapy and "shunt men off the evaluation superhighway" as needed to more efficiently identify other conditions within the differential diagnosis of BPH, Dr. McVary said.

In addition, the 2010 framework for diagnosis and treatment is based on an index patient age of 45 years. The index patient age was 50 years of age in the 2003 BPH guideline, but was lowered to encompass male LUTS rather than just BPH, he explained.

New in the discussion of medications are recommendations on the use of anticholinergic medications (antimuscarinics) and combination therapy with an alpha-blocker and 5-alpha-reductase inhibitor.