Patient discussions
Encourage patients to openly discuss bother and treatment effects during regular follow-up. Caution patients on adverse effects of medications (e.g., dizziness, impotence, gynecomastia). Warn the patient that acute progression of symptoms may indicate impending urinary retention for which catheterisation may be required. Patient symptomatology is a key indicator of the need for therapy, so encourage all untreated patients in watchful waiting to keep a diary of their voiding, including voided volume if possible.
When considering surgery (e.g., transurethral resection of the prostate), discuss the risk of complications, such as retrograde ejaculation or erectile dysfunction, and the patient’s priorities for treatment.[17][119] Explain that urinary incontinence following surgery is common, but usually temporary. Inform patients of conservative treatments for urinary incontinence after surgery, including lifestyle modifications, containment options, and pelvic floor muscle exercises (Kegel exercises).[18][120]
Use shared decision-making based on understanding the patient’s desires and risks associated with specific therapies to guide treatment strategies.[33] A decision-support tool may be useful; in the UK, the NHS has produced a tool to support informed shared decision-making. NHS England. Decision support tool: making a decision about enlarged prostate (BPE) Opens in new window
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