EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction
EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction
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DOI：
10.1016/j.eururo.2014.12.038
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发表时间：
2015-06-01
期刊：
影响因子：
23.4
通讯作者：
Gravas, Stavros
中科院分区：
文献类型：
--
作者：
Gratzke, Christian;Bachmann, Alexander;Gravas, Stavros
背景：下尿路症状（LUTS）是成年男性最常见的临床主诉之一，具有多因素病因。目的：制定欧洲泌尿外科协会（EAU）评估男性非神经源性LUTS的指南。证据获取：对非神经源性男性LUTS的评估进行了结构化的文献检索。选择具有最高可用证据水平的文章。采用德尔菲技术共识法制定建议。证据综合：作为男性LUTS初始评估的常规部分，必须记录病史，完成包含生活质量问题的有效症状评分问卷，应进行包括直肠指检在内的体格检查，必须安排尿液分析，测量空后残留尿液（PVR），并可进行尿流测定。应使用排尿频率-排尿量图表或膀胱日记来评估男性LUTS，并伴有明显的尿潴留或夜尿。前列腺特异性抗原（PSA）只有在前列腺癌的诊断将改变治疗或PSA可以帮助有症状进展和并发症风险的患者做出决策时才应该测量。如果病史和临床检查怀疑肾功能损害，如果患者有肾积水，或考虑对男性LUTS进行手术治疗时，必须评估肾功能。在任何治疗前都应进行尿流测量。LUTS患者的上尿路影像学检查应在PVR大、血尿或有尿石症病史的患者中进行。如果摄护腺造影有助于选择合适的药物和考虑手术治疗，则应进行摄护腺造影。只有LUTS患者应进行尿道镜检查，以排除可疑的膀胱或尿道病理和/或在微创/手术治疗前，如果发现可能改变治疗方法。压力-流量研究只能在手术前针对特定适应症的个别患者中进行，或者在需要评估LUTS的病理生理学基础时进行。结论：本指南为非神经源性男性LUTS的评估提供了循证实用指导。一个扩展版本可在网上获得（www.uroweb.org/guidelines）.Patient摘要：这篇文章介绍了欧洲泌尿外科协会关于非神经源性男性下尿路症状（LUTS）指南的简短版本。推荐的检查应能够区分无并发症的男性LUTS和可能的鉴别诊断，并评估治疗的基线参数。该指南还定义了患者的临床概况，以提供最佳的循证护理。开发了一种算法来指导医生使用适当的诊断测试。(C) 2014欧洲泌尿外科协会。Elsevier B.V.版权所有。
Context: Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology.Objective: To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS.Evidence acquisition: A structured literature search on the assessment of non-neurogenic male LUTS was conducted. Articles with the highest available level of evidence were selected. The Delphi technique consensus approach was used to develop the recommendations.Evidence synthesis: As a routine part of the initial assessment of male LUTS, a medical history must be taken, a validated symptom score questionnaire with quality-of-life question(s) should be completed, a physical examination including digital rectal examination should be performed, urinalysis must be ordered, post-void residual urine (PVR) should be measured, and uroflowmetry may be performed. Micturition frequency-volume charts or bladder diaries should be used to assess male LUTS with a prominent storage component or nocturia. Prostate-specific antigen (PSA) should be measured only if a diagnosis of prostate cancer will change the management or if PSA can assist in decision-making for patients at risk of symptom progression and complications. Renal function must be assessed if renal impairment is suspected from the history and clinical examination, if the patient has hydronephrosis, or when considering surgical treatment for male LUTS. Uroflowmetry should be performed before any treatment. Imaging of the upper urinary tract in men with LUTS should be performed in patients with large PVR, haematuria, or a history of urolithiasis. Imaging of the prostate should be performed if this assists in choosing the appropriate drug and when considering surgical treatment. Urethrocystoscopy should only be performed in men with LUTS to exclude suspected bladder or urethral pathology and/or before minimally invasive/surgical therapies if the findings may change treatment. Pressure-flow studies should be performed only in individual patients for specific indications before surgery or when evaluation of the pathophysiology underlying LUTS is warranted.Conclusions: These guidelines provide evidence-based practical guidance for assessment of non-neurogenic male LUTS. An extended version is available online (www.uroweb.org/guidelines).Patient summary: This article presents a short version of European Association of Urology guidelines for non-neurogenic male lower urinary tract symptoms (LUTS). The recommended tests should be able to distinguish between uncomplicated male LUTS and possible differential diagnoses and to evaluate baseline parameters for treatment. The guidelines also define the clinical profile of patients to provide the best evidence-based care. An algorithm was developed to guide physicians in using appropriate diagnostic tests. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.