Benign prostatic hyperplasia

Encourage patients to openly discuss bother and treatment effects during regular follow-up. Caution patients on adverse effects of medications (e.g., dizziness, impotence, gynecomastia). Warn the patient that acute progression of symptoms may indicate impending urinary retention for which catheterization may be required. Patient symptomatology is a key indicator of the need for therapy, so encourage all untreated patients in watchful waiting to keep a diary of their voiding, including voided volume if possible.

Use shared decision-making based on understanding the patient’s desires and risks associated with specific therapies to guide treatment strategies.[34]American Urological Association. Implementation of shared decision making into urological practice. 2022 [internet publication]. https://www.auanet.org/guidelines-and-quality/quality-and-measurement/quality-improvement/clinical-consensus-statement-and-quality-improvement-issue-brief-(ccs-and-qiib)/shared-decision-making ​ A decision-support tool may be useful; in the UK, the NHS has produced a tool to support informed shared decision-making. NHS England. Decision support tool: making a decision about enlarged prostate (BPE)​ Opens in new window