Treatment options for benign prostatic hyperplasia

Choice depends on patient's weighting of severity and bother, with risks and benefits of various options

Papers p 1059

Lower urinary tract symptoms consistent with benign prostatic hyperplasia become increasingly prevalent with age. While rarely life threatening, bothersome irritative urinary symptoms like urgency, frequency, and nocturia, and obstructive ones like a weak stream, hesitancy, intermittency, and incomplete emptying occur in up to 70% of men aged 70 years and older. Community and practice based studies suggest that men can expect slow progression of the symptoms. However, these symptoms can wax and wane without treatment, and rates of acute urinary retention range from 1-2% per year.1 By the age of 80 years, an estimated one in four men will have undergone treatment to relieve symptoms due to benign prostatic hyperplasia that reduce quality of life.2

Treatment options depend, in part, on the severity of symptoms and how bothersome they are. Options include watchful waiting (conservative or lifestyle management), phytotherapies, prescription medications, surgical procedures, and minimally invasive techniques. To help choose between treatments patients and providers rely on evidence from randomised controlled trials and systematic reviews to provide reliable information about efficacy and safety of various treatments.

For many years, transurethral resection of the prostate has been the gold standard treatment for benign prostatic hyperplasia. In 1994, almost 400 000 procedures were performed in the United States at a total cost of $5 billion.3 In the United Kingdom approximately 40 000 resections are carried out annually.4 …