**7.3 Medical treatment**

364 Chronic Kidney Disease

Pressure-flow studies can differentiate between patients with a low Qmax secondary to obstruction and those whose low Qmax is caused by a decompensated or neurogenic bladder. They are most useful for distinguishing between bladder outlet obstruction and

Urethrocystoscopy should not be done routinely but is optional during later evaluation if invasive treatment is strongly considered (McConnell, Barry et al. 1994). Nevertheless, it is a useful preoperative procedure to plan the most appropriate approach. This investigation can confirm causes of outflow obstruction while eliminating intravesical abnormalities.

Patients with mild symptoms are most appropriately managed by watchful waiting, patients with moderate symptoms should receive pharmacotherapy and patients with severe bother most benefit from surgical management. A man with preoperative IPSS ≥ 17 has an 87%

A group of patients at increased risk of progression can be identified on the basis of specific risk factors (e.g. age, symptoms, PSA level, Qmax, prostate volume and post-void residual urine). It might be appropriate to identify these patients at risk of progression and initiate early preventative treatment (Emberton et al., 2003)(Gabuev and Oelke 2011). For example, a higher frequency of kidney failure in patients presenting for prostate surgery than for nonprostate surgery has been shown, and several studies have shown improvement in

Patients who present to the emergency department with bladder outlet obstruction and high serum creatinine should receive a urethral catheter and subsequently evaluated in order to distinguish between acute and chronic renal failure. Hospitalization is often required in these cases. If ureterohydronephrosis and azotaemia persists despite bladder desobstruction, an ureterovesical junction obstruction should be considered and bilateral percutaneous nephrostomy or bilateral ureteric stents (if feasible) are advisable for

Neoureterocystostomy after a prostate ablative procedure may be adequate for definite

Watchful waiting (WW) is an appropriate strategy for men who are not bothered by their

This option should include education, reassurance, periodic monitoring and lifestyle advice to the patient. Lifestyle counseling include: reduction of fluid intake during specific times for control of urinary frequency (e.g. at night or when going out in public) but not of the

temporarily drainage. Patients may need urgent and transitory dialysis.

symptoms and have not developed BPH related complications.

chance of experiencing a substantial symptom reduction (Meigs, Mohr et al. 2001).

kidney function after prostatectomy (Hill et al., 1993).

ureterovesical junction obstruction resolution.

**6.11 Pressure-flow studies** 

impaired detrusor contractility.

**6.12 Urethrocystoscopy** 

**7. Treatment** 

**7.1 Acute treatment** 

**7.2 Watchful waiting** 

Medical approaches are not used to treat BPH complications (in which CKD is included). They are used for LUTS relief and for prevention of BPH progression (especially 5 alpha reductase inhibitors - 5-ARI).
