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".)
INDICATIONS FOR THERAPY
Medical treatment — The decision to medically treat benign prostatic hyperplasia (BPH) balances the severity of the patient's symptoms with potential side effects of therapy. Unless patients have developed bladder outlet obstruction, BPH only requires therapy if symptoms have a significant impact on a patient's quality of life . Symptoms typically appear slowly and progress gradually over a period of years. Even without therapy, many men will experience stabilization or improvement in symptoms over time . (See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia", section on 'Natural history'.)
For patients that require treatment, it is reasonable to initiate a trial of medical therapy for BPH when the clinician is comfortable that presenting signs and symptoms are consistent with BPH. (See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia", section on 'Diagnostic approach'.)
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- INDICATIONS FOR THERAPY
- Medical treatment
- Urologic referral prior to medical treatment
- BEHAVIORAL MODIFICATIONS
- INITIAL MEDICAL MONOTHERAPY
- Alpha-1-adrenergic antagonists
- - Efficacy and administration
- - Side effects and interactions
- Alternative medications
- - 5-alpha-reductase inhibitors
- Side effects
- - Anticholinergic agents
- - PDE-5 inhibitors
- COMBINATION THERAPY
- Alpha-1-adrenergic antagonist and 5-alpha-reductase inhibitor
- Alpha-1-adrenergic antagonist and anticholinergic
- REFERRAL FOR INVASIVE THERAPY
- HERBAL THERAPIES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS