Special Issue Urologic Diseases in Elderly Men Choong Hyun Lee, M.D. Department of Urology Kyung Hee University School of Medicine & Hospital E mail :

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1 Urologic Diseases in Elderly Men ChoongHyun Lee, M.D. Department of Urology Kyung Hee University School of Medicine & Hospital Abstract WWith the increasing life expectancy, health care providers are faced with a task to support the aging population to remain healthy and vital. Especially in Korea, the elderly population is increasing rapidly, and the urology, as a medical specialty, has become one of the biggest concerns. Four major, noncancerous diseases adversely affecting male individuals over 50 years of age include erectile dysfunction (ED), benign prostatic hyperplasia (BPH), cardiovascular disease (CVD), and depression. BPH is the most common benign neoplasm in aging men and the pathologic process also contributes to the development of lower urinary tract symptoms. The management of BPH has undergone tremendous changes in recent years. The introduction of new oral therapeutic agents has revolutionized the diagnosis and therapeutic approaches to ED. An increasing number of men are currently seeking medical attention for their sexual and voiding concerns, often visiting private physicians. In this article I will specifically focus on the guidelines for clinical evaluation and treatment of BPH and ED to update physicians' knowledge to improve the quality of clinical services. These guidelines highlight the evolving field of minimally invasive medical therapy through a tailored approach to meet each individual's expectation including oral agents as the first-line therapy. In case the firstline therapy fails, a referral to a specialist is recommended. Keywords : Guideline; Benign prostatic hyperplasia; Erectile dysfunction; Aging male 236

2 Initial Evaluation History DRE & Focused PE Urinalysis PSA in Select Patients Mild Symptoms (AUA/IPSS7) or No Bothersome Symptoms AUA/IPSS Symptom Index Assessment of Patient Bother Moderate/Severe Symptoms (AUA/IPSS8) Optional Diagnostic Tests Uroflow PVR Presence of Refractory Retention or Any of the following clearly related to BPH Persistent Gross Hematuria Bladder Stones Recurrent UTIs Renal Insufficiency Surgery Discussion of Treatment Options Patient Chooses Noninvasive Therapy Patient Chooses Invasive Therapy Optional Diagnostic Tests Pressure Flow Urethrocystoscopy Prostate Ultrasound Watchful Walting Medical Therapy Minimally Invasive Therapies Surgery DRE:, AUA: IPSS:, PE:, PSA:, PVR:, UTI: 2003 BPH 237

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