title: [Initial assessment, follow-up and treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: guidelines of the LUTS committee of the French Urological Association].
abstract: OBJECTIVE
  To elaborate guidelines for the diagnosis, the follow-up, and the treatment of benign prostatic hyperplasia (BPH).
  
  
  METHODS
  A systematic review of the literature was conducted to select more relevant publications. The level of evidence was evaluated. Graded recommendations were written by a working group, and then reviewed by a reviewer group according to the formalized consensus technique.
  
  
  RESULTS
  Terminology of the International Continence Society was used. Initial assessment has several aims: making sure that lower urinary tract symptoms (LUTS) are related to BPH, assessing bother related to LUTS and checking for a possible complicated bladder outlet obstruction (BOO). Initial assessment should include: medical history, LUTS assessment using a symptomatic score, physical examination including digital rectal examination, urinalysis, flow rate recording, and residual urine volume. Frequency volume chart is recommended when storage symptoms are predominant. Serum PSA should be done when the diagnosis of prostate cancer can modify the management. When a surgical treatment is discussed, serum PSA, serum creatinine and ultrasonography of the urinary tract are recommended. BPH patients should be informed of the benign and possibly progressive patterns of the disease. When LUTS cause no bother, annual follow-up should be planned. Medical treatment includes some phytotherapy agents, alpha-blockers and 5-alpha reductase inhibitors. The last two can be associated. The association of antimuscarinics and alpha-blockers can be offered to patients with residual storage symptoms when already under alpha-blockers therapy, after checking for the absence of severe BOO (residual volume more than 200mL or max urinary flow less than 10mL/s). Phosphodiesterase-5 inhibitors could be used in patients complaining for both LUTS and erectile dysfunction. In case of complication, or when medical treatment is inefficient or not tolerated, then a surgical treatment should be discussed. Treatment decision should be done according to type of LUTS and related bother, prostate anatomy, level of obstruction and its consequences on urinary tract, patient co-morbidities, experience of practitioner, and choice of patient. Surgical treatments with the higher level of evidence of efficacy include monopolar or bipolar transurethral resection of the prostate, open prostatectomy, transurethral incision of the prostate, photoselective vaporization of the prostate, and Holmium laser enuclation of the prostate.
  
  
  CONCLUSIONS
  Here are the first guidelines of the French Urological Association for the initial assessment, the follow-up and the treatment of urinary disorders related to BPH.
authors.affiliation: Service de chirurgie urologique, hôpital Dupuytren, CHU de Limoges, Limoges, France. aureliendescazeaud@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Descazeaud
authors.forename: G
authors.initials: G
authors.lastname: Robert
authors.forename: N B
authors.initials: NB
authors.lastname: Delongchamps
authors.forename: J-N
authors.initials: JN
authors.lastname: Cornu
authors.forename: C
authors.initials: C
authors.lastname: Saussine
authors.forename: O
authors.initials: O
authors.lastname: Haillot
authors.forename: M
authors.initials: M
authors.lastname: Devonec
authors.forename: M
authors.initials: M
authors.lastname: Fourmarier
authors.forename: C
authors.initials: C
authors.lastname: Ballereau
authors.forename: B
authors.initials: B
authors.lastname: Lukacs
authors.forename: O
authors.initials: O
authors.lastname: Dumonceau
authors.forename: A R
authors.initials: AR
authors.lastname: Azzouzi
authors.forename: A
authors.initials: A
authors.lastname: Faix
authors.forename: F
authors.initials: F
authors.lastname: Desgrandchamps
authors.forename: A
authors.initials: A
authors.lastname: de la Taille
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5 / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005602:France; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011470:Prostatic Hyperplasia / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D015415:Biomarkers; D018727:Muscarinic Antagonists; D058986:Phosphodiesterase 5 Inhibitors; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; D017430:Prostate-Specific Antigen