Benign prostatic hyperplasia: Part 2-management

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. a blockers are the most effective drug for improving lower urinary tract symptoms and short term quality of life.
Combination treatment (a blockers and 5a-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. 5a-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.