How to shape-up LUTS/BPH
guideline in Korea
-Follow-up단국의대 비뇨기과학교실
김형지
INTRODUCTION
BPH Guidelines
Diagnostic guidelines
Treatment guidelines
Follow-up guidelines

Guidelines
EAU BPH guidelines
AUA BPH guidelines
Canadian BPH guidelines
German BPH guidelines
Japan BPH guidelines
Australia BPH guidelines
WHO BPH guidelines
Malaysia, Singapore BPH guidelines
Diagnostic guideline에 중점을 두고 있다.
Treatment guideline은 나열식이 많다.
Follow-up에 대한 기술은 많지 않다.
EAU BPH guidelines
- Follow-up Watchful waiting
should be reviewed at 6 months and then
annually,
IPSS
Uroflowmetry
post-void residual urine volume.
Alpha-blocker therapy
should be reviewed after the first 6 weeks
If symptomatic relief and no side-effects, alphablocker therapy may be continued.
should be reviewed at 6 months and then annually,
provided there is no deterioration of symptoms
or development of absolute indications for
surgical treatment.
IPSS
Uroflowmetry
post-void residual urine volume
5-alpha-reductase inhibitors
should be reviewed after 12 weeks and at 6
months to determine their response.
Subsequent review is as for alpha-blocker
therapy.
IPSS
Uroflowmetry
post-void residual urine volume.
Surgical management
Within 6 weeks :
discuss the histological findings and
identify early post-operative morbidity.
At 3 months : the final outcome.
Patients who fail treatment should have
urodynamic studies with pressure-flow
analysis.
IPSS: recommended
Uroflowmetry: recommended
post-void residual urine volume:
recommended
Urine culture: optional
Histology: mandatory.
Alternative therapies
Long-term follow-up is recommended
because of concerns about the efficacy
and durability of alternative therapies.
The intervals for follow-up will depend on
the treatment modality employed.
Minimally invasive therapies:
within 6 weeks, at 3 months,
at 6 months, and then annually.
IPSS: recommended
Uroflowmetry and post-void residual urine
volume: recommended
Urine culture: optional
Histology where available: mandatory.
Recommended follow-up tests
after BPH treatment
Treatment
Modality
Examination
IPPS
WW
5 ARI
a-blockers
surgical
Non-surgical
+
+
+
+
+
uroflowmetry
+
+
+
+
+
postvoid
urine
residual
culture
urine volume
+
+
+
+
+
+
+
histology
+
+
Recommended follow-up interval
after BPH treatment
Treatment
Modality
First year after treatment
6weeks
WW
5 ARI
a-blockers
surgical
Non-surgical
+
+
+
12weeks
6month
+
+
+
+
+
+
+
+
thereafter
annually
+
+
+
+
+
Francois에 의한 guideline
Medical management of non-complicated BPH
Risk factors: prostate volume > 31 cm3, PSA > 1.6 ng/ml, RUV > 39 ml,
flow max < 10.6 ml
First line treatment of
non-complicated BPH
First line medical treatment failure:
persistence of bothersome symptoms
Francois, World Journal of Urology, 2006
Conclusion
대략 3개월 내지 6개월이면 임상평가를 하는
것으로 되어 있지만 임상평가에 대한 항목은
자세히 정해지지 않았다.
이는 evaluation에 대한 guideline이 정해지지
않은 것에 기인된 것으로 판단된다.