Medical treatment of benign prostatic hyperplasia
- Glenn R Cunningham, MD
Glenn R Cunningham, MD
- Distinguished Professor Emeritus, Department of Medicine
- Baylor College of Medicine
- Dov Kadmon, MD
Dov Kadmon, MD
- Professor of Urology
- Baylor College of Medicine
Benign prostatic hyperplasia (BPH) becomes increasingly common as men age. BPH can lead to urinary symptoms of increased frequency of urination, nocturia, hesitancy, urgency, and weak urinary stream. Symptomatic patients may benefit from medical or surgical treatment.
The medical therapy of BPH will be reviewed here. The clinical manifestations and diagnosis, epidemiology and pathogenesis, and surgical and other invasive therapies of BPH are all discussed separately. (See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia" and "Epidemiology and pathogenesis of benign prostatic hyperplasia" and "Transurethral procedures for treating benign prostatic hyperplasia".)
Treatment of lower urinary tract symptoms in men from etiologies other than BPH is also discussed separately. (See "Lower urinary tract symptoms in men".)
Behavioral interventions — In patients with symptoms of benign prostatic hyperplasia (BPH) who do not have any discomfort from their symptoms and have no evidence of complications (such as bladder outlet obstruction, renal insufficiency, or recurrent infection), pharmacologic treatment may not be necessary [1,2]. These patients may be monitored and advised regarding behavioral modification.
Behavioral modification may be helpful for all patients. For example, patients may benefit from voiding in the sitting position (rather than standing) . Other behavioral modifications include:
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- GENERAL CONSIDERATIONS
- Behavioral interventions
- Indications for medical treatment
- When to refer to urologist
- INITIAL MEDICAL MONOTHERAPY
- Alpha-1-adrenergic antagonists
- - Efficacy and administration
- - Side effects and interactions
- Alternative medications
- - 5-alpha-reductase inhibitors
- Side effects
- - Anticholinergic agents
- - Phosphodiesterase-5 inhibitors
- COMBINATION THERAPY
- Alpha-1-adrenergic antagonist and 5-alpha-reductase inhibitor
- Alpha-1-adrenergic antagonist and anticholinergic
- HERBAL THERAPIES
- REFERRAL FOR SURGICAL MANAGEMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS