VA Boston Healthcare System, Department of Surgery, West Roxbury, Massachusetts.
J Urol. 2021 Oct;206(4):806-817. doi: 10.1097/JU.0000000000002183. Epub 2021 Aug 13.
Benign prostatic hyperplasia (BPH) is a histologic diagnosis describing proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The prevalence and severity of lower urinary tract symptoms (LUTS) in aging men are progressive and impact the health and welfare of society. This revised Guideline provides a useful reference on effective evidence-based management of male LUTS/BPH. See the accompanying algorithm for a summary of the procedures detailed in the Guideline (figures 1 and 2[Figure: see text][Figure: see text]).
The Minnesota Evidence Review Team searched Ovid MEDLINE, Embase, Cochrane Library, and AHRQ databases to identify eligible English language studies published between January 2008 and April 2019, then updated through December 2020. Search terms included Medical Subject Headings (MeSH) and keywords for pharmacological therapies, drug classes, and terms related to LUTS or BPH. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, information is provided as Clinical Principles and Expert Opinions (table 1[Table: see text]).
Nineteen guideline statements pertinent to evaluation, work-up, and medical management were developed. Appropriate levels of evidence and supporting text were created to direct both primary care and urologic providers towards streamlined and suitable practices.
The work up and medical management of BPH requires attention to individual patient characteristics, while also respecting common principles. Clinicians should adhere to recommendations and familiarize themselves with standards of BPH management.
良性前列腺增生（BPH）是一种组织学诊断，描述了前列腺移行区平滑肌和上皮细胞的增殖。下尿路症状（LUTS）在老年男性中的患病率和严重程度是逐渐进展的，并影响社会的健康和福利。本修订指南为男性 LUTS/BPH 的有效循证管理提供了有用的参考。请参见随附的算法，以总结指南中详细介绍的程序（图 1 和 2[图：见正文][图：见正文]）。
明尼苏达证据审查小组在 Ovid MEDLINE、Embase、Cochrane 图书馆和 AHRQ 数据库中搜索了 2008 年 1 月至 2019 年 4 月期间发表的符合条件的英文研究，并在 2020 年 12 月之前进行了更新。搜索术语包括医学主题词（MeSH）和药物治疗、药物类别以及与 LUTS 或 BPH 相关的术语的关键词。当存在足够的证据时，证据体被分配为 A（高）、B（中）或 C（低）的强度等级，以支持强、中或条件推荐。在缺乏足够证据的情况下，将作为临床原则和专家意见提供信息（表 1[表：见正文]）。
制定了 19 条与评估、检查和药物治疗相关的指南陈述。创建了适当的证据水平和支持文本，以指导初级保健和泌尿科医生采用简化和合适的实践。
BPH 的检查和药物治疗需要注意患者的个体特征，同时也要尊重一般原则。临床医生应遵守建议并熟悉 BPH 管理标准。
