Medical Management of Benign Prostatic Hyperplasia

The goal of medical management for benign prostatic hyperplasia (BPH) is to improve lower urinary tract symptoms (LUTS) of affected patients. Therapy is generally focused on mitigating the dynamic or static components of BPH pathophysiology. Alpha-adrenergic receptor blockers (alpha-blockers) are the most common first-line medication for BPH and function by inhibiting dynamic prostatic smooth muscle contraction to prevent bladder outlet obstruction. The medications in this class are equally effective and well tolerated, but medication side effects of hypotension, dizziness, and retrograde ejaculation determine specific medication selection for treatment. Androgen manipulation via 5 alpha-reductase inhibitors alleviates static components of LUTS by decreasing prostate size. This medication class can potentiate sexual side effects but has been shown to be extremely effective in conjunction with alpha-blockers. Phosphodiesterase inhibitors have demonstrated efficacy in treating men with BPH and coexisting erectile dysfunction, but their mechanism of improving LUTS is unclear. Anticholinergic and beta-3-agonist medications are indicated for patients with overactive bladder symptoms in the setting of BPH due to their ability to reduce detrusor spasms and increase bladder relaxation.