Current Treatment for Benign Prostatic Hyperplasia

Abstract

Background: Benign prostatic hyperplasia (BPH) is characterized by the occurrence of.disorders of urine storage and bladder emptying. Most men over the age of 60 years are affected to some degree.

Methods: A selective literature search with additional scrutiny of guidelines and meta-analyses.

Results: The management of patients with BPH is complex. Emptying and retention disorders can be treated by various pharmacological and surgical means. Transurethral resection of the prostate (TURP) has long been considered the gold standard for operative treatment. Transurethral enucleation procedures show a better risk profile in some uses, however, and have, above all, largely displaced suprapubic prostatectomy. Numerous innovative treatment options have been developed in recent years, but their long-term effects remain to be determined. These treatment techniques can nevertheless be used in individual cases after thorough discussion with the patient.

Conclusion: The care of patients with BPH should be interdisciplinary. The efficacy and safety of many new developments in the area of pharmacological and minimally invasive treatment remain to be demonstrated in randomized trials.

Figure

Flow chart for recommendation medical management of patients with possibly BPH-related symptoms, based on the guidelines of the European Society of Urology [recommended scope of follow-up: history, IPSS, ICIQ, IIEF, urinalysis, physical examination (including DRE), PSA, urinary tract ultrasonography as appropriate] (1) BPH, benign prostatic hyperplasia; DRE, digital rectal examination; HoLEP, holmium laser enucleation of the prostate; ICIQ, International Consultation on Incontinence Questionnaire; IIEF, International Index of Erectile Function; IPSS, International Prostate Symptom Score; PSA, prostate-specific antigen; PVR, postvoid residual urine; TUIP, transurethral incision of the prostate; ThuLEP, thulium laser enucleation; TURP, bipolar transurethral prostateresection