Patient handout

Benign Prostatic Hyperplasia (BPH) — chronic LUTS in adult men

PRODUCTION

1. Your condition

This handout is for benign prostatic hyperplasia (bph) — chronic luts in adult men. Your care team identified this based on: frequency / urgency / nocturia (storage) ± urge incontinence in adult man (aua bph 2021 pmid 34384237).

Other reasons your team may use this plan: weak stream / hesitancy / intermittency / incomplete emptying / straining (voiding) in adult man (aua bph 2021); inability to void + palpable bladder + suprapubic pain — aur (stat decompression); post-void dribbling (post-micturition) in adult man (eau bph 2015).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
Lifestyle modification — fluid timing, caffeine / EtOH reduction, avoid OTC anticholinergics / decongestants	—	—	—	AUA BPH 2021 — first-line for mild symptoms; no medication exposure (PMID 34384237)

Plan: BPH — AUA 2021 ladder: lifestyle → α-blocker → 5-ARI / combo → PDE5i overlay → antimuscarinic for storage → surgery for refractory

3. When to call your provider

Contact your care team if any of the following happen:

Refractory on max combination at 6–12 mo → urology referral for surgical evaluation (AUA BPH 2021)
Recurrent UTI in adult man → urology + complicated UTI workup overlap (uro.uti.complicated.v1)
Hematuria persisting on UA → AUA 2020 microhematuria workup (route to symptom.hematuria.v1)
AUR / hydronephrosis / obstructive AKI → ED + admit
DRE nodule + elevated PSA velocity → urology + biopsy (prostate cancer pivot)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Severe LUTS (IPSS ≥20) with high bother — combination α-blocker + 5-ARI if prostate >40 cc; consider surgical evaluation (AUA BPH 2021)
AUR with palpable bladder + suprapubic pain + inability to void — STAT Foley + α-blocker + TWOC at 24–72 h (AUA BPH 2021)
Bilateral hydronephrosis + obstructive AKI — STAT urology + decompression (Foley vs PCN); admit (AUA BPH 2021; KDIGO AKI 2026)(life-threatening)
Breakthrough on max combination therapy at 6–12 mo — urology referral for surgical evaluation (AUA BPH 2021)
Post-TURP / open prostatectomy bleeding — CBI; transfusion if Hb threshold; cystoscopy + clot evacuation if persistent (AUA BPH 2021)

5. Follow-up

Annual IPSS + DRE; surgical referral if breakthrough on combination after 6–12 mo; counsel lifelong trajectory + IFIS (cataract surgery interaction) + retrograde ejaculation expectation + 5-ARI sexual / mood effects (AUA BPH 2021)

6. Sources

Guideline: AUA BPH 2021 Parts I/II + AUA BPH 2023 amendment + MTOPS NEJM 2003 (McConnell/Lepor combination superiority) + CombAT 4-year (dutasteride + tamsulosin) + EAU non-neurogenic male LUTS/BPO 2015 + UroLift L.I.F.T. (minimally invasive) + USPSTF PSA screening 55-69 shared decision