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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Cite this: Bradley Schwartz. Fast Five Quiz: Test Your Knowledge of Benign Prostatic Hyperplasia - Medscape - Mar 09, 2017.
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