The doctor should conduct a physical examination, including a digital rectal examination, urinalysis, and serum creatinine measurement. A patient-centered approach to treatment is central to the guideline. Unless patients have specific complications due to BPH, they should, in consultation with their doctors, decide on the treatment after understanding likely treatment outcomes. To decide on a treatment, a patient must consider how bothered he is by his symptoms and weigh how he feels about the likely benefits and risks of each treatment. These patients should be monitored annually.
Some patients improve without active medical or surgical treatment.
Prostate surgery offers the best chance of symptom improvement. However, surgery also has the highest rate of significant complications. Of the available surgical procedures, TUIP has the lowest risk of operative complications. TUIP is not, however, appropriate for all patients. Because of its high long-term failure rate, balloon dilation is not commonly used.