Non-malignant prostate enlargement causing LUTS in older men.
History taking
- • IPSS — voiding (hesitancy, weak stream, incomplete emptying) and storage (frequency, urgency, nocturia)
Examination
- • DRE: smooth, firm, enlarged
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Urinalysis, PSA (counsel), U&E
- • USS post-void residual, uroflowmetry
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Tamsulosin 400 µg OD (α-blocker)
- • Add finasteride / dutasteride if large prostate >30 g
- • Tadalafil 5 mg OD if concurrent ED
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Urology for refractory symptoms, retention, haematuria, raised PSA
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
