PURPOSE: In Korea, there was no specific guidelines for the management of benign prostatic hyperplasia (BPH). We reviewed the practice patterns of Korean urologists in the management of BPH and aimed to describe the need to develop specific guidelines. MATERIALS AND METHODS: A probability sample was taken from the Korean Urological Association Registry of Physicians, and a structured questionnaire, that explored practice patterns in the management of BPH, was mailed to a random sample of 251 Korean urologists. RESULTS: For the initial evaluation of BPH, most urologists routinely performed prostatic specific antigen (PSA) (96.4%), digital rectal exam (94.4%), international prostate symptom score (IPSS) (83.2%) and transrectal ultrasound (79.2%). Symptom assessment (36.4%) followed by transrectal ultrasound of prostate (TRUS) (20.0%) was considered as the most important diagnostic examination affecting the decision about individual treatment options. Almost all urologists (92.2%) chose medical treatment as the first-line treatment option for uncomplicated BPH with moderate symptoms. Of the respondents, 57.2% had prescribed alpha blocker and 41.6% alpha blocker plus 5-alpha reductase inhibitors as the medical treatment option for BPH. The prescription of 5-ARIs was dependent on the size of the prostate and the severity of symptoms. CONCLUSION: The results of our current survey provide useful insight into variations in the clinical practice of Korean urologists. They also indicate the need to develop further practical guidelines based on solid clinical data and to ensure that these guidelines are widely promoted and accepted by the urological community.
Adrenergic alpha-Antagonists/therapeutic use ; Cholestenone 5 alpha-Reductase/antagonists & inhibitors ; Data Collection ; Humans ; Korea ; Male ; Prostatic Hyperplasia/*diagnosis/*drug therapy ; Urology/statistics & numerical data

PURPOSE: We assessed whether weight reduction is an effective intervention for the management of lower urinary tract symptoms (LUTS) and investigated the relationship between obesity and LUTS. MATERIALS AND METHODS: This was a prospective randomized controlled trial that enrolled obese men older than 50 years with LUTS. The study period was 52 weeks. All patients received standardized alpha-adrenergic blocker therapy for the treatment of benign prostatic hyperplasia (BPH) during the run-in period. Patients were randomized to receive either a standardized prerecorded video program on the general principle of weight reduction or a comprehensive weight reduction program. Patients were assessed at different time points with symptom assessment, uroflowmetry, transrectal ultrasound, and metabolic assessment. RESULTS: Sixty-five patients were allocated to each study arm. After the study period, no significant difference in weight reduction was found between the two arms. When the pre- and postintervention parameters were compared, none were statistically different between the 2 arms, namely nocturia, International Prostate Symptom Score, quality of life assessment, and uroflowmetry parameters. When the whole study population was taken as a single cohort, these parameters were also not significantly different between the group with a body mass index of 25 to <30 kg/m2 and the group with a BMI of 30 to 35 kg/m2. CONCLUSIONS: We found no association between obesity and LUTS. This could have been due to the less marked weight difference in our cohort. Whereas weight reduction may be an effective measure to improve LUTS, the implementation of a successful program remains a challenge.
Adrenergic alpha-Antagonists/*therapeutic use ; Aged ; Body Mass Index ; Humans ; Lower Urinary Tract Symptoms/*drug therapy ; Male ; Middle Aged ; *Obesity ; Prospective Studies ; Prostatic Hyperplasia/diagnosis/*drug therapy ; Quality of Life ; Severity of Illness Index ; Treatment Outcome ; *Weight Loss

PURPOSE: In order to gain insight into the physicians' awareness of and attitude towards management of overactive bladder (OAB) in males, we performed a nationwide survey of the current strategies that urologists use to diagnose and manage OAB in male patients. MATERIALS AND METHODS: A probability sample was taken from the Korean Urological Association Registry of Physicians, and a random sample of 289 Korean urologists were mailed a structured questionnaire that explored how they manage benign prostatic hyperplasia (BPH). RESULTS: A total of 185 completed questionnaires were returned. The consent rate in the survey was 64.5%. Eighty-one (44%) urologists believed that of all males with lower urinary tract symptoms (LUTS), 20% or more had OAB and 72 (39%) believed that 10-20% had OAB. Half of the urologists surveyed believed that the most bothersome symptom in male OAB patients was nocturia. Seventy-three percent of respondents reported that they prescribed alpha blockers with anticholinergics for first line management, while 19% of urologists prescribed alpha blocker monotherapy but not anticholinergics for OAB patients. Though acute urinary retention (AUR) was considered the anticholinergic adverse event of most concern, the most frequently observed adverse event was dry mouth (95%). CONCLUSION: The present study provides insights into urologist views of male OAB. There is a discrepancy between the awareness of urologists and actual patterns of diagnosis and treatment of male OAB. This finding indicates the need to develop further practical guidelines based on solid clinical data.
Adrenergic alpha-Antagonists/therapeutic use ; Cholinergic Antagonists/therapeutic use ; *Health Knowledge, Attitudes, Practice ; Humans ; Male ; Physician's Practice Patterns ; Physicians/*psychology ; Prostatic Hyperplasia/diagnosis/drug therapy/pathology ; Questionnaires ; Urinary Bladder Neck Obstruction/diagnosis/drug therapy/pathology ; Urinary Bladder, Overactive/*diagnosis/drug therapy/pathology ; Urinary Retention/diagnosis/drug therapy/pathology ; *Urology

The availability of new urologic medications has made it possible to manage a variety of urologic disorders successfully in a primary care setting. As a result, primary care physicians(PCPs) need to be familiar with the terminology and screening instruments used by urologists to decipher and categorize urologic symptoms. PCPs are often responsible for the treatment of lower urinary tract symptoms and benign prostatic hyperplasia(BPH). Evolving strategies of management include utilization of both symptom-modifying treatment and disease-modifying treatment. Alphablockers excellently provide symptomatic treatment, but do not alter long-term disease progression. 5-alpha reductase inhibitors can reduce the need for surgical intervention and the incidence of acute urinary retention. The combination of alphablockers and 5-alpha reductase inhibitors would be the choice of therapy in some patients, typically those with large prostate glands indicative of disease progression. Overactive bladder(OAB) is defined as urinary urgency with or without urge incontinence, usually with frequency and nocturia, in the absence of a pathologic or metabolic condition that can explain these symptoms. The diagnosis of OAB should be made after a careful history taking, physical examination, laboratory evaluation, and use of tools such as voiding diaries. Anticholinergic agents are the first choice for drug therapy. Treatment that couples drug therapy with behavioral techniques aimed at modifying abnormal voiding patterns may provide the best outcomes in many patients with OAB. There are situations for referring patients to urologists for more detailed evaluation and management, including when the PCP has a lack of interest in or sufficient knowledge about lower urinary tract symptoms and if the patient shows a poor response to prior noninvasive therapy, requiring in-depth investigation.
5-alpha Reductase Inhibitors ; Cholinergic Antagonists ; Diagnosis ; Disease Progression ; Drug Therapy ; Family Characteristics ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Mass Screening ; Nocturia ; Physical Examination ; Primary Health Care* ; Prostate ; Prostatic Hyperplasia ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge ; Urinary Retention

AIMTo describe an unusual symptom of benign prostatic hyperplasia (BPH).

METHODSA patient presented to our urology clinic having experienced post-coital gross hematuria for 2 years. He had not experienced lower urinary tract symptoms (LUTS). A series of examinations were performed to determine the source of bleeding.

RESULTSThe prostate was defined as the active bleeding source responsible for the patient's post-coital hematuria. Endoscopic fulguration did not alleviate the symptom. The use of dutasteride, a dual inhibitor of 5alpha-reductase, solved the problem.

CONCLUSIONThis study reports for the first time that post-coital gross hematuria is one of the clinical presentations of BPH, which can be successfully treated with 5alpha-reductase inhibitor.

5-alpha Reductase Inhibitors ; Azasteroids ; therapeutic use ; Coitus ; physiology ; Dutasteride ; Enzyme Inhibitors ; therapeutic use ; Hematuria ; drug therapy ; etiology ; physiopathology ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; diagnosis ; physiopathology ; Urinary Tract