title: [Guide dedicated to general practitioner for the management of lower urinary tract symptoms related to benign prostatic hyperplasia].
abstract: OBJECTIVE
  To establish a guide dedicated to general practitioner for the diagnosis, the follow-up, and the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH).
  
  
  METHODS
  Guidelines already published for urologists were modified to make them relevant for general practitioners. The role of specialist's referral was defined. The whole content of the document was submitted to the formal consensus process in which urologists and general medicine teachers were involved.
  
  
  RESULTS
  Initial assessment has several aims: making sure that LUTS are related to BPH, assessing bother related to LUTS, and checking for a possible complication. Initial assessment should include: medical history, physical examination with digital rectal examination, and urinalysis. Some other explorations such as frequency volume chart, serum PSA or creatinine, and ultrasonography of the urinary tract were found optional, meaning they are necessary only in specific situations. Referring to urologist is justified when LUTS might not be related to BPH (particularly when urgencies are predominant), or when a severe bladder outlet obstruction is suspected (severe symptoms, palpable bladder, post-voiding residual volume>100ml), or when a complication is assessed. Follow-up without treatment is justified for patients with no bothersome symptoms related to not complicated BPH. Several drugs are available for the treatment of bothersome symptoms related to BPH. Alpha-blockers and plants extracts might be offered as monotherapy. Five alpha reductase inhibitors might be offered to patients with LUTS related to a significant prostate hypertrophy (>40 ml) ; they might be given for a minimum duration of one year, alone or in association with alpha-blocker. The association of antimuscarinic and alpha-blocker might be used in patients with persistent storage LUTS in spite of alpha-blocker treatment. Phosphodiesterase 5 inhibitors might be offered to patients with erectile dysfunction associated with LUTS related to BPH. In case of complicated BPH, or when medical treatment is not efficacious or not tolerated, a surgical option should be discussed.
  
  
  CONCLUSIONS
  The male lower urinary tract symptom committee of the French Urological Association and general practitioner present the first guide for the management of LUTS related to BPH dedicated to general practitioner.
  
  
  METHODS
  5.
authors.affiliation: Service de chirurgie urologique, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France. Electronic address: aureliendescazeaud@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Descazeaud
authors.affiliation: Service d'urologie, CHU Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Unité Inserm 1151, Institut Necker-Enfants-Malades, 75015 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Barry Delongchamps
authors.affiliation: Service d'urologie, université Paris-6, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
authors.forename: J-N
authors.initials: JN
authors.lastname: Cornu
authors.affiliation: Service d'urologie, CHU d'Angers, 49933 Angers, France.
authors.forename: A R
authors.initials: AR
authors.lastname: Azzouzi
authors.affiliation: Département de médecine générale, faculté de médecine, université de Limoges, 2, rue du Dr-Marcland, 87000 Limoges, France.
authors.forename: D
authors.initials: D
authors.lastname: Buchon
authors.affiliation: 9-bis, rue Porte-de-Buc, 78000 Versailles, France.
authors.forename: A
authors.initials: A
authors.lastname: Benchikh
authors.affiliation: Service d'urologie, centre hospitalier René-Dubos, 6, avenue Île-de-France, 95300 Pontoise, France.
authors.forename: P
authors.initials: P
authors.lastname: Coloby
authors.affiliation: Service d'urologie, clinique Turin, 9, rue de Turin, 75008 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Dumonceau
authors.affiliation: Service d'urologie, centre hospitalier Aix-en-Provence, 13616 Aix-en-Provence, France.
authors.forename: M
authors.initials: M
authors.lastname: Fourmarier
authors.affiliation: Service d'urologie, CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France.
authors.forename: O
authors.initials: O
authors.lastname: Haillot
authors.affiliation: Service d'urologie, CHU d'Angers, 49933 Angers, France.
authors.forename: S
authors.initials: S
authors.lastname: Lebdai
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guillou, 35000 Rennes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Service d'urologie, clinique Pasteur, 45, avenue de Lombez, 31300 Toulouse, France.
authors.forename: V
authors.initials: V
authors.lastname: Misrai
authors.affiliation: Service d'urologie, CHU, 1, place de l'hôpital, 67000 Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Saussine
authors.affiliation: Service d'urologie, CHU Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France.
authors.forename: A
authors.initials: A
authors.lastname: de La Taille
authors.affiliation: Service d'urologie, université de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France.
authors.forename: G
authors.initials: G
authors.lastname: Robert
mesh_terms: D058006:General Practice; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D011470:Prostatic Hyperplasia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
keywords: Benign prostatic hyperplasia; General practitioners; Hyperplasie bénigne de la prostate; Lower urinary tract symptoms; Médecine générale; Symptômes du bas appareil urinaire