老年出生男性常见患良性前列腺增生（BPH）引起的下尿路症状，无论性别认同如何，由此引起症状的治疗在初级保健实践中很常见。2021年，美国泌尿科协会发布了BPH管理指南。他们建议使用标准化评分系统如国际前列腺症状评分表来帮助确定诊断和监测干预的疗效，α-受体阻滞剂作为首选药物治疗选项，而5α-还原酶抑制剂用于前列腺估计体积至少为30 cc的患者。泛泰达是另一种选择，无论是否存在勃起功能障碍。联合使用α-受体阻滞剂和5α-还原酶抑制剂、抗胆碱药物或β3-兴奋剂的组合疗法是有效的选择。当BPH导致慢性肾脏病、难以治愈的尿潴留或反复发作的泌尿道感染；当担心有膀胱或前列腺癌的风险；或当症状不响应医疗治疗时，必要时可进行手术转诊。在本文中，一位普通内科医师和一名泌尿科医生讨论了治疗选择，并说明了他们如何应用建议向希望了解更多治疗选择的患者提供建议。

Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are common in older patients assigned male sex at birth, regardless of gender identity, and treatment of these symptoms is therefore common in primary care practice. In 2021, the American Urological Association published guidelines for management of BPH. They recommend using a standardized scoring system such as the International Prostate Symptom Score to help establish a diagnosis and to monitor the efficacy of interventions, α-blockers as the first-choice pharmacotherapy option, and 5α-reductase inhibitors for patients with prostate size estimated to be at least 30 cc. Tadalafil is another option regardless of erectile dysfunction. Combination therapies with α-blockers and 5α-reductase inhibitors, anticholinergic agents, or β3-agonists are effective options. A surgical referral is warranted if the BPH results in chronic kidney disease, refractory urinary retention, or recurrent urinary tract infections; if there is concern for bladder or prostate cancer; or if symptoms do not respond to medical therapy. In this article, a general internal medicine physician and a urologist discuss the treatment options and how they would apply their recommendations to a patient who wishes to learn more about his options.