This protocol covers the management of benign prostatic hyperplasia (BPH) in patients whose primary symptom burden consists of moderate to severe storage lower urinary tract symptoms — the dominant presentation driving treatment selection in this group.
Patients in this population present with BPH in which storage symptoms predominate at a moderate to severe level. This symptom pattern is the defining criterion for this protocol and determines the pharmacological strategy used.
Anticholinergic agents are a central component of the approach for this scenario — used either alone or in combination with an agent from another drug class. A further combination option exists for patients where a different pharmacological pairing is more appropriate. The complete agent selection, criteria for monotherapy versus combination, and sequencing are specified in the full protocol.
The primary treatment target is a clinically meaningful reduction in International Prostate Symptom Score (IPSS): a decrease of more than 3 points from baseline. Response is assessed at 4–12 weeks after initiating treatment.
DOI: 10.1097/JU.0000000000003698
Anticholinergic agents, alone or in combination with an alpha blocker, may be offered as a treatment option to patients with moderate to severe predominant storage LUTS.
Beta-3-agonists in combination with an alpha blocker may be offered as a treatment option to patients with moderate to severe predominate storage LUTS.
Patients should be evaluated by their providers 4-12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy.
For IPSS this is a difference of >3 points.
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