Fast Five Quiz: Test Your Knowledge of Benign Prostatic Hyperplasia

Bradley Schwartz, DO


March 09, 2017

Watchful waiting is the recommended strategy for patients with BPH who have mild symptoms (International Prostate Symptom Score/American Urological Association Symptom Index [IPSS/AUA-SI] score ≤ 7) and for those with moderate to severe symptoms (IPSS/AUA-SI score ≥ 8) who are not bothered by their symptoms and are not experiencing complications of BPH. In those patients, medical therapy is not likely to improve their symptoms and/or quality of life.

In current clinical practice, most patients with BPH do not present with obvious surgical indications; instead, they often have milder LUTS and, therefore, are initially treated with medical therapy.

The era of medical therapy for BPH dawned in the mid-1970s with the use of nonselective alpha-blockers such as phenoxybenzamine. The medical therapeutic options for BPH have evolved significantly over the past 3 decades, giving rise to the receptor-specific alpha-blockers that comprise the first line of therapy.

Historically, anticholinergics were discouraged in men with BPH because of concerns of inducing urinary retention. Trials have demonstrated a slight increase in postvoid residual (PVR) urine volumes; however, AUR rates were low. Of note, these trials consisted of patients with low baseline PVR urine volumes.

For more on the surgical treatment of BPH, read here.

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