Benign prostatic hyperplasia (BPH) is estimated to affect 3.2 million men in the UK; however, only a minority of them, around 400000, currently receive either medical or surgical treatment. In spite of the creation of several guidelines specifically dealing with the problems resulting from BPH,1,2 GPs still seem to be reluctant to embrace the management of this highly prevalent disorder. There are several reasons for this: first, in the UK, BPH is not included in the so-called Quality and Outcomes Framework (QOF) and therefore there is little incentive for GPs to become involved. Second, there is still considerable uncertainty about the role and value of a digital rectal examination (DRE) and prostate-specific antigen (PSA) testing as a means of identifying BPH and excluding prostate cancer. Third, many GPs are unfamiliar with the medications used for the management of BPH and how they should be best deployed. Finally, there is still confusion about the target values for symptom score and reduction of acute urinary retention (AUR) rates that ideally should be achieved in response to medical therapy, and if and when the patient should be referred for specialist evaluation.
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