Intended for healthcare professionals


BMJ Learning: Benign prostatic hyperplasia: treatment in primary care

BMJ 2006; 333 doi: (Published 07 September 2006) Cite this as: BMJ 2006;333:535
  1. Anand K Patel, research registrar1,
  2. Christopher R Chapple, professor of urology and consultant urological surgeon (
  1. 1 Urology Research, J Floor, Royal Hallamshire Hospital, Sheffield S10 2JF
  1. Correspondence to: CR Chapple
  • Accepted 3 August 2006

This article provides information on how to treat patients with lower urinary tract symptoms that are suggestive of bladder outflow obstruction, secondary to benign prostatic hyperplasia

How do I treat it?

The treatment of lower urinary tract symptoms that are suggestive of bladder outflow obstruction, secondary to benign prostatic hyperplasia, should aim to relieve symptoms and improve quality of life, as well as attempt to prevent progression of clinical disease and the development of complications. These benefits need to be balanced against potential side effects of treatment.

Watchful waiting

Patients with mild symptoms that have little impact on quality of life and who have no evidence of complications can be managed conservatively. They should be advised to reduce fluid intake and avoid caffeinated drinks and alcohol if appropriate. This requires the use of frequency and voiding charts.

It may be helpful to review the drugs they are taking, such as diuretics, and any impairment of mental state, dexterity, or mobility should be optimised to limit the impact on quality of life.1Patients selected for watchful waiting should be encouraged to seek medical advice if their symptoms deteriorate, so appropriate treatment can be initiated promptly.

Medical treatment

Options if medical treatment is needed are:

  • α Antagonists

  • 5α Reductase inhibitors

  • Combination therapy.

α Antagonists

Contraction of the prostatic smooth muscle occurs after activation of the α1 adrenoceptors. Inhibition of these receptors relaxes the muscle in the bladder out-flow tract; this decreases urinary outflow resistance and helps improve the symptoms. α Antagonists are the first line treatment for benign prostatic hyperplasia.

Summary points

Benign prostatic hyperplasia leads to progressive clinical disease in a proportion of patients

α Antagonists rapidly improve lower urinary tract symptoms, and alfuzosin and tamsulosin (as once daily preparations) are the safest options

5α Reductase inhibitors reduce prostatic volume by 20-30% but take up to six months to improve symptoms

5α …

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