What is the initial management of benign prostatic hyperplasia?

This study reviewed the initial management of benign prostatic hyperplasia (BPH).  

BPH is a condition in which the prostate grows and can compress the urethra (the tube that passes urine out of the bladder), leading to difficulty passing urine. Symptoms include needing to urinate frequently, dribbling flow, and urinary retention where the urine cannot pass out of the bladder. Urinary retention can be very painful and often requires a catheter to be passed into the bladder to allow the urine to drain.

BPH symptoms are treated initially with lifestyle changes and then with medications. If this treatment is not successful a surgical procedure is sometimes needed. This study reviews and recommends the best way to manage early BPH.

This study reviewed all relevant studies on the management of BPH from 2008-2020. It put together recommendations based on all these studies:

Patients should discuss lifestyle measures with their physician. This includes reducing caffeine and alcohol intake and reducing fluids, especially in the evening.

Medical treatment should also be discussed. Alpha-blockers such as doxazosin (Cardura), tamsulosin (Flomax), silodosin (Rapaflo), alfuzosin (Uroxatral), and terazosin (Hytrin) are the first choice of medication. Side effects of alpha-blockers include sexual dysfunction and changes in blood pressure. If patients are considering cataract surgery, they should discuss this medication with their eye doctor.

The second choice of medical treatment is alpha-reductase inhibitors (5-ARIs) such as finasteride (Proscar) and dutasteride (Avodart). Alpha-blockers and 5-ARIs can be used together when there is a definite enlargement of the prostate (over 30cc volume). 

Tadalafil (Cialis) can be added to treatment in patients with or without erectile dysfunction. 

This study reviewed the first-line management option recommendations for patients with BPH.

This study is intended to provide general guidelines for treatment. Different individual factors will impact what treatment course is best for any individual patient.