Noninvasive treatment of benign prostatic hyperplasia. Where do we stand in 2005

ABSTRACT

Noninvasive treatment of lower urinary tract symptoms [LUTS] due to benign prostatic hyperplasia [BPH] includes self-management and medical treatment. Self-management should be encouraged as an initial step for all men with uncomplicated LUTS/BPH. It consists of 3 elements, namely education and reassurance, lifestyle modification of fluid intake and concurrent medical therapy and finally behavioral interventions including management of post-void dribbling and bladder retraining. If self-management fails, medical or surgical interventions are required. Further, research is required to define and test the effectiveness of self-management either as a primary intervention or to augment existing medical therapies. Benign prostatic hyperplasia patients in need of rapid onset of symptom relief and those with small prostates benefit from the use of alpha-blockers. Although 5-alpha-reductase inhibitors [5 ARIs] provide symptomatic benefits, the onsets of these are slower than those observed with the alpha-blockers. Amongst available therapies, only 5 ARIs have been shown to reduce the risk of acute urine retention [AUR] and BPH-related surgery compared to placebo. The Medical Therapy of Prostatic Symptoms [MTOPS] Study provides rational basis for combined alpha-blockers plus 5 ARIs in patients with a high index of disease progression [prostate volume >30 g and prostate-specific antigen >1.6 ng/ml]. Preliminary studies suggest that anticholinergics could be safe in LUTS/BPH and can help to alleviate irritative bladder symptoms due to overactive bladders commonly associated with BPH