Clinical Review

Benign prostatic hyperplasia. Part 2—Management

BMJ 2008; 336 doi: 10.1136/bmj.39433.670718.AD (Published 24 January 2008)
Cite this as: BMJ 2008;336:206

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  1. Timothy J Wilt, professor of medicine1,
  2. James N’Dow, professor of urology2
  1. 1Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, USA
  2. 2Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD
  1. Correspondence to: T J Wilt tim.wilt{at}med.va.gov

    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

    • α blockers are the most effective drug for improving lower urinary tract symptoms and short term quality of life

    • Combination treatment (α blockers and 5α-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

    • 5α-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. Short term repeat intervention and urinary retention rates are higher than with transurethral resection of the prostate. Long term effect is unclear

    Management of benign prostatic hyperplasia (BPH) is mainly directed at improving bothersome lower urinary tract symptoms. The vast majority of men with these symptoms initially present to primary care seeking information about the risks and benefits of available treatments. Few men require urgent referral to a specialist for additional diagnostic testing or management. This article provides evidence to guide primary care doctors in the treatment of men with lower urinary tract symptoms, with emphasis on BPH. A previous article discussed diagnosis.1

    What treatment options exist?

    Treatment goals are to improve bothersome symptoms, prevent symptom progression, and reduce longer term complications (including acute urinary retention, incontinence, recurrent urinary tract infections, renal insufficiency, and the need for surgery).2 3 Options include observation (watchful waiting); lifestyle management; modification of existing medications and/or management of …

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