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June 7, 1995


Author Affiliations

University of California, Los Angeles

JAMA. 1995;273(21):1725-1726. doi:10.1001/jama.1995.03520450095050

The medical outcomes and practice guidelines movements profoundly affected the field of urology in 1994 with the long-awaited publication of the Clinical Practice Guideline for Benign Prostatic Hyperplasia (BPH) from the US Agency for Health Care Policy and Research.1 Intended for use by primary care providers as well as urologists, the guideline provides a straightforward algorithm for the diagnosis and treatment of obstructive urinary symptoms in men older than 50 years. It is an evidence-based guideline, developed by a multidisciplinary panel of experts during several years of work.2

In the guideline, diagnostic evaluation relies heavily on the patient's own symptom assessment using the American Urological Association Symptom Index, a seven-item questionnaire that focuses on incomplete emptying, weak or intermittent stream, urgency, hesitancy, and nocturia.3 This questionnaire is a psychometrically valid and reliable self-administered instrument that scores obstructive voiding symptoms on a scale from 0 to 35, with

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