Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop
lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (
TURP) was the mainstay of treatment. However, several efficacious
drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α
adrenoceptor antagonists can significantly ameliorate
lower urinary tract symptoms. Moreover, 5α
reductase inhibitors, alone or combined with an α
adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of
urinary retention and the need for surgical intervention. Newer medical regimens including the use of
antimuscarinic agents or
phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant
erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or
pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave
thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of
TURP. A variety of
laser procedures have also been introduced, whose improved
hemostatic properties abrogate many of the complications associated with traditional surgery.