A REVIEW OF THE INVESTIGATION AND MEDICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

Summary

This review will cover the assessment of benign prostatic hyperplasia (BPH) and discuss the established and upcoming medical treatment options available to an urologist. We evaluate the evidence base underlying current guidelines thereby providing recommendations for a structured approach to managing patients with lower urinary tract symptoms (LUTS) thought to be secondary to BPH. We examine the indications for the different alpha antagonists, 5 alpha reductase inhibitors and review the data for combination therapy. The use of new therapies such as intraprostatic injection of botulinum toxin therapy may become established, however much work still needs to be carried out as the evidence base, as is so often the case, is inadequate to suggest use of new emergent techniques outside of clinical trials. Surgical the­rapy is being used less frequently to manage BPH, however it is still the treatment of choice when complications of BPH such as retention have developed. In conclusion LUTS are highly prevalent in elderly males, being consequent upon many different pathologies, and need appropriate assessment, counselling, management and follow up for which there are many modalities of available treatment.

KEY WORDS:
benign prostatic hyperplasia (BPH) - lower urinary tract symptoms (LUTS) - bladder ouflow obstruction (BOO) - alpha antagonists - 5 alpha reductase inhibitors - combination therapy - discontinuation therapy - botulinum toxin