Benign Prostatic Hyperplasia (BPH)

•RCT evidence— Decades of urology trials

Symptoms

Lower urinary tract symptoms (LUTS) from BPH include:

• Storage: frequency, urgency, nocturia.
• Voiding: weak stream, hesitancy, intermittency, incomplete emptying.
• Post-micturition: dribbling, sensation of incomplete emptying.

Medical treatments

• Alpha-1 blockers (tamsulosin, alfuzosin, silodosin): rapid onset (days); reduce smooth-muscle tone in prostate/bladder neck. Side effects: orthostatic hypotension, retrograde ejaculation, intraoperative floppy iris syndrome (alert ophthalmologist before cataract surgery).
• 5-alpha reductase inhibitors (finasteride, dutasteride): slow onset (months); shrink prostate by ~20%. Side effects: reduced libido, ED, gynaecomastia in small fraction; post-finasteride syndrome controversy.
• PDE5 inhibitors (tadalafil 5 mg/day): for men with concurrent ED; modest BPH benefit.
• Beta-3 agonists (mirabegron): for storage symptoms.
• Anticholinergics: for overactive bladder symptoms; caution in elderly (cognitive effects).

Procedural options

When medical therapy is insufficient:

• TURP: gold-standard surgical reduction.
• Laser therapies (HoLEP, GreenLight).
• Water vapour thermal therapy (Rezum).
• Prostatic artery embolisation.
• Prostatic urethral lift (UroLift) for selected patients.

Related entries

Prostate cancer (cancer overview), Testosterone.