Benign prostatic hyperplasia (BPH)

Use at a glance

• Mild symptoms → watchful waiting/lifestyle

Practical pearls

• Alpha-1 blocker gives fastest symptom relief
• Large prostate → add 5-alpha-reductase inhibitor

Treatment options

• Tadalafil helps BPH + erectile dysfunction
• Retention/recurrent infection → procedure referral
• Choose drug by BP + sexual adverse effects

Choosing treatment

• Combination if high progression risk

Key points

• Any severity: fluid restriction, frequent voiding, avoid bladder irritants
• Mild: watchful waiting, monitor q6–12 mo; moderate–severe: drug therapy
• Alpha blockers 1st-line for moderate–severe; rapid relief, no effect on progression
• 5-ARIs (finasteride, dutasteride) shrink prostate, ↓ retention/surgery; alone or + alpha blocker if enlarged
• Tadalafil: option with comorbid ED or to offset sexual adverse effects
• Storage symptoms: add anticholinergic or beta-3 agonist to alpha blocker
• Acute retention: ≥3 days alpha blocker before trial without catheter

Nonpharmacologic therapies

• Watchful waiting
• Fluid restriction
• Timed and double voiding
• Pelvic floor training
• Weight loss
• Limit caffeine and alcohol
• Avoid bladder irritants
• Surgery

Pearls

• Doxazosin, terazosin: most hypotension; titrate slowly
• Tamsulosin, silodosin: most ejaculatory dysfunction
• 5-ARIs need up to 6 months for full effect
• Check post-void residual before adding an anticholinergic
• Saw palmetto and other supplements don't work

Self-check

• How are mild BPH symptoms managed?
  Watchful waiting/lifestyle.
• What is added for a large prostate?
  Add 5-alpha-reductase inhibitor.

Drugs used for this (16)

All clinical uses · Open Benign prostatic hyperplasia (BPH) in the interactive console ↗