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Patients’ preferences and expectations depend on cultural, geographical, economic and national factors. Data from different countries should be interpreted with caution when applied to the individual patient. Patients rarely seek help for benign prostatic obstruction (BPO) unless urinary retention occurs, but they are commonly referred for lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement (BPE). The long-standing issue of treatment outcome in patients with or without BPO remains unsolved. The role of prostatic infections/inflammation/prostate infarction remains debatable. Evidence suggests that inflammation is what causes retention in patients with small prostates. The experience suggests that patients are not interested in the diagnosis of bladder outlet obstruction; they care more about improving their symptoms (International Prostate Symptom Score), quality of life (QoL) and disease progression. Whether in digital or paper form, voiding diaries are of the greatest clinical value and use should be encouraged. Urologists were tailoring BPE management for individual patients well before the concept of personalised / precision medicine was popularised. A limitation of our current practice is that all treatment options are rarely available in all centres and we sometimes manage our patients with a limited armamentarium. In addition, improving communication skills and adopting a patient-centred approach may help clinicians to better manage LUTS/BPE patients. Many patients often present because of a fear of having cancer. Prostate enlargement as such is a natural consequence of ageing and not a disease. A weak flow rate (with prostate enlargement) should never be considered per se as an indication for surgery. The risk of bladder dysfunction from BPO is one of the issues for which there is very limited evidence. Patients should be informed that BPE is a benign condition. Managing BPE involves much more than performing transurethral resection of the prostate, Urolift® or holmium laser enucleation of the prostate. New technologies to treat BPE are evolving every day, but which one is superior no one knows. We must ensure that patients are well informed on management options and that those offered address patients’ preferences.

Male lower urinary tract symptoms and benign prostatic obstruction: what do patients want?
De Nunzio C, Lombardo R, Tubaro A.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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