A practical primary care approach to overactive bladder.

The evaluation and treatment of overactive bladder (OAB) starts in the primary care office and can be accomplished efficiently, effectively and, most importantly, safely. With appropriate knowledge of the disease and an understanding of what to look for the primary care physician (PCP) can readily make the empiric diagnosis and initiate treatment. The key for the PCP is to be able to distinguish the uncomplicated patient from the complicated one and know when to refer, if necessary. It is also essential to be able to able to identify confounding conditions that could either be the cause of the symptoms or, in fact, make them worse. The algorithm presented in this paper describes a simplified, yet complete, approach to the patient presenting with lower urinary tract symptoms (LUTS) consistent with OAB. In the paper, we explain the disease itself, its prevalence and impact, the evaluation as well as the different treatment modalities that are available for the patient. Appropriate follow up, therapy adherence techniques and referral recommendations are also discussed.

A practical primary care approach to lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH-LUTS).

In the primary care office the evaluation of prostate related lower urinary tract symptoms (BPH-LUTS) in the male can be confusing. Are the symptoms, in fact, from the prostate or is there another etiology such as the bladder or medical conditions causing or contributing to the problems? If the cause is the prostate, how does the physician choose from the multitude of available treatment options and when is referral appropriate? The prevalence of BPH-LUTS is high and commonly encountered by the primary care physician (PCP). An understanding of the normal prostate is essential to identifying the patient when symptoms do occur. Then the evaluation and treatment of the affected patient can occur effectively and efficiently in the PCP setting. In this article we present the background information needed for the PCP to provide this evaluation of the patient with BPH-LUTS. We explain the various treatment options that are best suited for the individual which are based on symptom severity, sexual dysfunction and risk of progression. We also identify follow up parameters and reasons for referral.