BMJ  2008;336:206-210 (26 January), doi:10.1136/bmj.39433.670718.AD

Clinical Review

Benign prostatic hyperplasia. Part 2—Management

¹ Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, USA, ² Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD

The first 150 words of the full text of this article appear below.

Summary points Treatment should improve patients’ symptoms and reduce progression and need for surgery while minimising harms and costs Management includes observation, lifestyle modification, drug treatment, minimally invasive surgery, and surgical removal of prostate tissue blockers are the most effective drug for improving lower urinary tract symptoms and short term quality of life Combination treatment ( blockers and 5-reductase inhibitors) reduces progression of benign prostatic hyperplasia and need for surgery if the symptoms are moderate or severe and the prostate glands large, if taken for more than a year; adverse events increase 5-reductase inhibitors may reduce risk of prostate cancer but may increase the risk of high grade disease Transurethral resection of the prostate results in the greatest improvement in symptoms and flow rate, but adverse effects include the risk of surgery Minimally invasive surgery can provide benefits comparable to transurethral resection of the prostate, with fewer serious adverse effects. . . . [Full text of this article]

What treatment options exist?

Treatment options for lower urinary tract symptoms
Observation or watchful waiting
Lifestyle modification
Treatment of comorbid contributing conditions
Drug treatments
Major surgical treatments
Minimally invasive surgical treatments
Lifestyle management
Drug therapy
Monotherapy with -1 selective adrenergic antagonists or 5-reductase inhibitors
Combination therapy
Phytotherapy
Antimuscarinics for storage problems

What are the benefits and harms of surgery?

Current standard
New technology
Adverse effects of surgery

When is referral to a urologist indicated?

Data sources
Additional educational resources
Ongoing research
Unanswered questions

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