What are the approach considerations for the treatment of benign prostatic hyperplasia (BPH)?

Updated: Feb 19, 2021
  • Author: Levi A Deters, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Watchful waiting is the recommended strategy for patients with BPH who have mild symptoms (International Prostate Symptom Score/American Urological Association Symptom Index [IPSS/AUA-SI] score ≤7) and for those with moderate-to-severe symptoms (IPSS/AUA-SI score ≥8) who are not bothered by their symptoms and are not experiencing complications of BPH. In those patients, medical therapy is not likely to improve their symptoms and/or quality of life (QOL).

In addition, the risks of treatment may outweigh any benefits in such cases. Patients managed expectantly with watchful waiting are usually re-examined annually.

Metabolic syndrome is associated with a higher prevalence and severity of BPH. [11, 10, 12]  Thus, it may be possible to  postpone the progression of BPH by lowering blood glucose, improving insulin resistance, and reducing inflammation through a healthy lifestyle and clinical treatment. [12]

The era of medical therapy for BPH dawned in the mid 1970s with the use of nonselective alpha-blockers such as phenoxybenzamine. The medical therapeutic options for BPH have evolved significantly since then, with the development of receptor-specific alpha-blockers that comprise current first-line therapy, as well as the approval of 5-alpha-reductase inhibitors.

TURP has long been accepted as the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH. In current clinical practice, most patients with BPH do not present with obvious surgical indications; instead, they often have milder lower urinary tract symptoms (LUTS) and, therefore, are initially treated with medical therapy. Several minimally invasive treatments for BOO are also available.

A guideline from the American Urological Association outlines clinical scenarios in which surgery is recommended for LUTS/BPH. The AUA guideline also suggests interventional techniques that can be used as alternatives to TURP (see Guidelines). [1]

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