Materiały źródłowe

• #1 Current Treatment for Benign Prostatic Hyperplasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8021971/

  Benign prostatic hyperplasia (BPH) is characterized by the occurrence of disorders of urine storage and bladder emptying. Most men over the age of 60 years are affected to some degree. […] The management of patients with BPH is complex. Emptying and retention disorders can be treated by various pharmacological and surgical means. Transurethral resection of the prostate (TURP) has long been considered the gold standard for operative treatment. Transurethral enucleation procedures show a better risk profile in some uses, however, and have, above all, largely displaced suprapubic prostatectomy. Numerous innovative treatment options have been developed in recent years, but their long-term effects remain to be determined. These treatment techniques can nevertheless be used in individual cases after thorough discussion with the patient.

• #1 Diagnosis and Management of Benign Prostatic Hyperplasia | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0515/p1403.html

  Benign prostatic hyperplasia is a common condition affecting older men. […] Over the past decade, numerous medical and surgical interventions have been shown to be effective in relieving symptoms of benign prostatic hyperplasia. Alpha blockers improve symptoms relatively quickly. […] For men with mild symptoms, watchful waiting with annual reassessment is appropriate. […] Alpha blockers provide symptomatic relief of moderate to severe BPH symptoms. […] In men with a prostate volume greater than 40 mL, 5-alpha reductase inhibitors should be considered for the treatment of BPH. […] Watchful waiting is recommended in men who have mild symptoms (AUA Symptom Index score of 7 or less) or who do not perceive their symptoms to be particularly bothersome. […] Alpha blockers relieve symptoms in men with moderate to severe BPH.

• #1 Enlarged prostate: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000381.htm

  The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your provider will also take into account other medical problems you may have. […] Treatment options include „watchful waiting,” lifestyle changes, medicines, or surgery. […] If you have BPH, you should have a yearly assessment to monitor your symptoms and see if you need changes in treatment. […] For mild symptoms: Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don’t feel a need to urinate. Avoid alcohol and caffeine, especially after dinner. Do not drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime. Try not to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These medicines can increase BPH symptoms. Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms. Reduce stress. Nervousness and tension can lead to more frequent urination.

• #1 Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate – Urology | UCLA Health

  https://www.uclahealth.org/medical-services/urology/conditions-treated/male-conditions/benign-prostatic-hyperplasia-bph

  Benign prostatic hyperplasia (BPH) is a non-cancerous condition that affects a substantial number of men as they age. […] These symptoms can be detrimental to a patients health and quality of life, and can easily be treated with medications and procedures. […] There are now many effective treatment options from which to choose, including new medications; lower-risk, less invasive enlarged prostate surgeries; and alternative approaches such as herbal supplements. […] At UCLA Health Urology we offer a broad range of treatment options for BPH including, medications, surgery and minimally invasive procedures. […] For minor symptoms, certain lifestyle changes can help, including limiting beverages consumed in the evening, reducing alcohol and caffeine consumption, and avoiding intake of diuretics, antihistamines and decongestants.

• #1 Current Treatment for Benign Prostatic Hyperplasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8021971/

  The care of patients with BPH should be interdisciplinary. The efficacy and safety of many new developments in the area of pharmacological and minimally invasive treatment remain to be demonstrated in randomized trials. […] Drug therapy should be considered if the patients symptom burden requires it or if initial watchful waiting has not led to satisfactory improvement in symptoms. The choice of drug therapy depends on the symptoms. […] In patients with predominantly storage symptoms, muscarinic receptor antagonists and 3-adrenoceptor agonists may be used. […] Treatment with alpha1-receptor inhibitors (alpha-blockers), phosphodiesterase 5 (PDE5) inhibitors, or 5-alpha-reductase inhibitors may be considered in patients with predominantly voiding dysfunction. […] Alpha-blockers + 5-alpha-reductase inhibitors can further increase improvement in LUTS and Qmax, so long as increased rates of adverse effects are accepted, and can also reduce the risk of acute urinary retention and the need for surgery.

• #1 Medical management of benign prostatic hyperplasia | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/3/163

  Medical management of benign prostatic hyperplasia (BPH) has progressed gradually in recent years and remains the starting point for most symptomatic patients seeking treatment. […] Treatment with phosphodiesterase-5 inhibitors helps maintain ejaculatory function and may provide additional relief of irritative symptoms, including urgency and frequency, compared with alpha-blockers and 5-alpha reductase inhibitors. […] Medical therapy for BPH with lower urinary tract symptoms should be initiated after evaluation of the potential benefits and side effects of specific medications. […] Alpha-blockers are a class of drugs first introduced in the late 1980s and early 1990s. […] The therapeutic effect of alpha-blockers starts within hours to days, although it generally takes 3 to 7 days to reach maximum effect.

• #1 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-%28bph%29-guideline

  When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. […] Clinicians should offer one of the following alpha blockers as a treatment option for patients with bothersome, moderate to severe LUTS/BPH: alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin. […] 5-ARIs alone or in combination with alpha blockers are recommended as a treatment option to prevent progression of LUTS/BPH and/or reduce the risks of urinary retention and need for future prostate-related surgery. […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies.

• #1 Medical management of benign prostatic hyperplasia | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/3/163

  Inhibiting the conversion of testosterone to dihydrotestosterone with 5-alpha reductase inhibitors (5ARIs) can reduce prostate growth and tip the scales toward prostatic cellular apoptosis and atrophy. […] 5ARIs should be reserved for patients with BPH and lower urinary tract symptoms who have prostate glands 30 cc or larger or palpable prostatic enlargement on digital rectal examination. […] Phosphodiesterase-5 (PDE5) inhibitors increase intracellular cyclic guanosine monophosphate, causing nitric oxide-mediated relaxation of smooth muscle throughout the prostate, detrusor muscle (bladder), and urethra. […] Beta-3 agonists, including mirabegron and vibegron, work via the sympathetic pathway to cause relaxation of the detrusor muscle and increase bladder capacity. […] Combination pharmacotherapy has been shown to be more effective than monotherapy or placebo, specifically in patients with larger prostates who meet criteria for 5ARIs and can be offered alpha-blockers simultaneously. […] Several options exist for medical management of BPH, and choices are affected by indication, effectiveness, and side effects.

• #1 Treatment of BPH – medication – Prostate Matters

  https://prostatematters.co.nz/benign-prostatic-hyperplasia-bph/treatment-of-bph-medication/

  Before medication, try the following life style changes to see if they help: […] If these steps are not enough, medications taken singly or in combination can help. […] The most frequently used drug is tamsulosin. Urinary symptoms improve two or three days in 70% of men who take it and the benefit can last several years. […] About 1 in 7 men may feel dizzy because the blood pressure drops, 1 in 12 men feel tired and do not ejaculate semen when they have an orgasm. […] The commonest used is finasteride and then dutasteride. Symptoms improve after 6 to 12 months, so patience is needed, but fewer men need surgery if 5ARI are taken for many years. […] These include oxybutynin, solifenacin and trospium. […] The main drug used is tadalafil. It can take one to four weeks before you notice a benefit, and the benefit is slightly less than with alpha blockers.

• #1 Medical Treatment of Benign Prostatic Hyperplasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3151584/

  In summary, men with clinical BPH are best treated initially with -blocker monotherapy to relieve LUTS. […] In the subset of men with large prostates, both -blockers and 5-ARIs significantly decrease LUTS, and this clinical benefit appears to be additive. […] In men with large prostates, 5-ARIs are superior to -blockers at preventing AUR and BPH surgery; however, one has to treat a large cohort of men for 4 years with the addition of a 5-ARI to prevent a single episode of AUR or BPH surgery.

• #1 Guidelines for the Treatment of Benign Prostatic Hyperplasia

  https://www.uspharmacist.com/article/guidelines-for-the-treatment-of-benign-prostatic-hyperplasia

  Benign prostatic hyperplasia (BPH) is a common disorder in men with an incidence that increases with age. BPH often requires therapy when patients begin to experience lower urinary tract symptoms that affect quality of life. Current management strategies involve lifestyle modifications, pharmacotherapy, phytotherapy, and surgical interventions as indicated. […] The goal of treatment is to relieve LUTS and slow the clinical progression of BPH while improving patient QOL. […] If lifestyle modifications are insufficient in improving QOL, then pharmacotherapy may be indicated in patients who do not have absolute indications warranting surgery. […] Current oral pharmacotherapy options for managing BPH include alpha-adrenergic antagonists (alpha-blockers), 5-alpha-reductase inhibitors (5ARIs), muscarinic receptor antagonists (MRAs), and phosphodiesterase 5 (PDE5) inhibitors.

• #1 Current Treatment for Benign Prostatic Hyperplasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8021971/

  Invasive treatment should be considered if medical therapy fails to provide adequate symptom relief or is refused by the patient (relative indication for surgery), or if any of the following are present: recurrent or refractory urinary retention, overflow incontinence, refractory macrohematuria, dilatation of the upper urinary tract with or without renal insufficiency, recurrent urinary tract infections, or bladder stones or diverticula (absolute indications for surgery). […] Transurethral resection of the prostate (TURP) and suprapubic enucleation procedures have become established as the gold standard of practice. […] Recently, several new surgical technologies have been developed to give patients effective treatment on an outpatient basis, without general anesthesia and with short recovery times, minimal morbidity rates, preservation of sexual function, and a good safety profile.

• #1 Benign prostatic hyperplasia (BPH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

  Many treatments are available for enlarged prostate. These include medicines, surgery and procedures that involve smaller, fewer or no cuts. The best treatment choice for you depends on: […] Taking medicine is the most common treatment for mild to moderate symptoms of an enlarged prostate. Options include: […] Surgery or other procedures might help with BPH symptoms if you: […] Any type of prostate procedure can cause side effects. Depending on the procedure you choose, health issues afterward might include: […] There are many types of surgeries and other procedures that can treat an enlarged prostate. […] A thin tool with a light, called a scope, is inserted into the urethra. The surgeon removes all but the outer part of the prostate. TURP often relieves symptoms quickly. […] A lighted scope is inserted into the urethra. The surgeon makes one or two small cuts in the prostate gland. This makes it easier for urine to pass through the urethra.

• #1 Epidemiology and treatment modalities for the management of benign prostatic hyperplasia – Lokeshwar – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/30514/html

  After lifestyle modifications, medication is generally first line in the treatment of symptomatic BPH. Two drug classes became accepted standard of care in the late 1980s early 1990s; 5-alpha-reductase inhibitors such as finasteride and Alpha-blockers like terazosin. […] The interventional management of BPH is another option for patients who are suitable for surgical procedure and is generally offered to patients with persistent or severe BPH refractory to medical therapy. […] TURP has long been considered the historical gold standard for the surgical treatment of BPH. […] HoLEP has been described as the emerging gold standard for BPH surgical management in the twenty-first century however the implementation of this surgical technique faces the obstacle of a steep learning curve. […] With its FDA approval for the use as a BPH treatment modality in 2013, PUL has been increasing in popularity amongst clinicians. […] Within the past decade, a multitude of novel treatment modalities have emerged for the treatment of BPH. […] Current research supports that each laser modality is on par or superior to the standard TURP.

• #1 Benign prostatic hyperplasia (BPH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

  A special catheter is placed through the urethra into the prostate area. Microwave energy from the catheter destroys the inner portion of the enlarged prostate gland. […] A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy has a lower risk of side effects than does nonlaser surgery. […] Special tags are used to compress the sides of the prostate. This can improve the flow of urine. […] A device is placed in the urethra. It turns water into steam. This wears away extra prostate tissue. […] This procedure uses imaging tests and robotic tools to guide a device into the urethra. The device releases tiny, powerful jets of water to remove extra prostate tissue. […] You may be offered prostate artery embolization as a treatment option for BPH. In this procedure, the blood supply to the prostate is blocked in chosen areas. This causes the prostate to get smaller.

• #1 Overview of treatments for Benign Prostatic Hyperplasia (BPH) – Prostate Matters

  https://prostatematters.co.uk/determining-suitable-bph-treatment-options/overview-of-treatments-for-benign-prostatic-hyperplasia-bph/

  A number of techniques to form instant cavities within the prostate. This can be carried out by electrosurgery, laser therapy or most recently, high pressure water jets. […] REZUM (interstitial water vapour therapy) Here, steam is injected into the prostate- this can in some units be done under local anaesthetic as an outpatient. […] Trans-Urethral Resection of the Prostate (TURP): This has been the standard of care now for many decades in Western countries and involves a telescope being inserted through the eye of the penis and use a superheated electric wire which allows small pieces of prostate (these look a little like pieces of mince) to be removed step by step from the prostate. […] Laser prostatectomy can be carried out using two different techniques; the first is vaporisation where a laser is used to turn tissue into steam creating a cavity and the second, by enucleation where the laser is used as a knife to remove large chunks of the prostate which are then removed from the bladder using tissue destruction device inserted through the telescope called a morcellator.

• #1 New BPH treatment ablates the prostatic tissue without heat – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/urology/news/new-bph-treatment-ablates-the-prostatic-tissue-without-heat/mac-20573532

  Benign prostatic hyperplasia (BPH) is one of the most common diagnoses in men over the age of 50. […] Initial treatments often include behavioral modifications and medications, but if these fail to improve symptoms, then surgery is the next best option. […] The goal of a BPH surgery is to open the prostatic urethra to allow for a stronger urinary stream and to help facilitate complete bladder emptying. […] The best surgical option is often individualized for each patient depending on the prostate size, symptom severity and patient priority in terms of sexual function preservation. […] Meghan A. Cooper, D.O., a urology consultant at Mayo Clinic in Rochester, Minnesota, brought Aquablation to the practice to treat this niche area within the BPH population. „We’re excited to offer this new surgical BPH option to our patients, and we’ve seen a large influx of patients who are looking specifically for this treatment,” says Dr. Cooper.

• #1

  https://journals.lww.com/ursc/fulltext/2023/34020/treatment_of_benign_prostatic_hyperplasia__update.2.aspx

  Novel beta-3 agonists function on the beta-3 adrenoceptor which is a major role in mediating human detrusor relaxation. […] Minimally invasive surgical treatments are innovative options for those who were unresponsive to medication or transurethral resection of the prostate (TURP). […] Aquablation, executed using the Aquabeam system, is an innovative technology incorporating real-time image-based ultrasonic guidance and robotics with high-pressure saline jet for resection of prostate parenchymal tissue. […] Rezum System utilizes convective radiofrequency water vapor to ablate obstructive prostate tissue. […] Prostate artery embolization (PAE) employs several embolic agents to blockade prostatic arterial blood flow, facilitating local tissue infarction and necrosis, and further shrinkage of prostate size after necrotic tissue desquamation.

• #1 Benign prostate enlargement | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/benign-prostate-enlargement/

  Transurethral resection of the prostate (TURP) involves inserting a small instrument called a resectoscope into your urethra, the tube that carries urine from the bladder to the penis. […] Holmium laser enucleation of the prostate (HoLEP) is similar to a TURP. […] The insertion of prostatic urethral lift implants is a new surgical procedure that can help relieve urinary symptoms. […] Transurethral vaporisation of the prostate (TUVP) is similar to a TURP, but parts of the prostate are destroyed (vaporised) rather than cut away. […] An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement.

• #1 Benign Prostatic Hyperplasia (BPH) | Duke Health

  https://www.dukehealth.org/treatments/urology/benign-prostatic-hyperplasia

  During this surgery, BPH tissue is removed systematically to open a channel in the prostate, making it easier to urinate and reduce urinary symptoms. This procedure is the most commonly performed BPH surgery in the United States. […] Your doctor may recommend that you undergo robotic BPH surgery if the prostate grows too large, you have other related bladder and prostate conditions, or other surgical treatments aren’t effective. Your doctor will consider the size of your prostate to determine the best approach to this surgery. […] Duke Health is a high-volume, regional referral center for people who need advanced and complex BPH surgery. Our urologists who treat BPH and prostate problems are board-certified and have undergone additional advanced training through fellowships in laser surgery and robotics.

• #1 Benign Prostatic Hyperplasia (BPH): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-hyperplasia

  Benign prostatic hyperplasia (BPH) causes your prostate to increase in size. Symptoms include difficulty peeing and a sudden need to pee. Treatment includes medications, surgery and minimally invasive procedures. […] There isnt a cure for BPH. However, treatment options are available to help alleviate your symptoms. […] Treatment options include: […] The most commonly prescribed medications relax the muscle in your prostate, which reduces tension on your urethra. […] Several different types of surgery can remove prostate tissue that blocks your urethra. […] New BPH treatments are less invasive and damaging to healthy tissue than surgery. […] TURP is the most effective treatment for most cases of BPH. […] However, in adults 65 and older, medications and minimally invasive treatments are preferable. […] The outlook for people with BPH is very good. BPH doesnt have a cure, but treatments can help alleviate your symptoms. Mild symptoms may not require treatment. Medications, surgery and minimally invasive treatments can treat more severe cases.

• #1 Benign Prostatic Hyperplasia (BPH) Treatments | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/urology/benign-prostatic-hyperplasia/treatments

  Treatment options for BPH are medical, procedural and surgical. Typically, these options will be tried in that order to obtain symptom relief. However, if you have a coexisting condition, we may recommend a procedure or surgery without trying medication. Coexisting conditions that can affect your treatment options include: […] These conditions are indicators that medical treatment alone is unlikely to prevent future complications of BPH. […] The mainstay of medical treatment are the so-called alpha-blockers, for example, tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). The mechanism of the medication is to decrease tension in the enlarged prostate so that urine can flow easier past the obstructive tissue. […] If therapy with a single alpha-blocker does not relieve symptoms, finasteride or dutasteride can be added to the treatment plan.

• #1 Considerations for Choosing Treatment Options for Benign Prostatic Hyperplasia – European Medical Journal

  https://www.emjreviews.com/urology/article/considerations-for-choosing-treatment-options-for-benign-prostatic-hyperplasia-j180121/

  The EAU, UK NICE, and AUA have all issued guidelines on the surgical management of BPH by both invasive and MIST procedures and endorse the use of PUL of the management of LUTS due to BPH. […] PUL is the only MIST to be recommended with a strong strength rating for the treatment of LUTS in the EAU guidelines. PUL is the only MIST mentioned in EAUs treatment algorithm for bothersome LUTS, and is recommended for all patients, regardless of level of risk, for prostate volumes between 30 and 80 mL. […] NICE recommends PUL for treating LUTS due to BPH, as PUL relieves lower urinary tract symptoms, avoids risk to sexual function, and improves QoL. […] The AUA guideline amendment 2019 on the surgical management of LUTS attributed to BPH states that PUL may be offered as an option for patients with LUTS caused by BPH, provided that the prostate size is less than 80 g, and that there is a verified absence of an obstructive middle lobe.

• #1 Benign Prostatic Hyperplasia (BPH) Treatment & Management: Approach Considerations, Alpha-Blockers, 5-Alpha-Reductase Inhibitors

  https://emedicine.medscape.com/article/437359-treatment

  TURP is considered the criterion standard for relieving BOO secondary to BPH. […] There is considerable interest in the development of other therapies to decrease the amount of obstructing prostate tissue while avoiding the above-mentioned adverse effects associated with TURP. […] Open prostatectomy is now reserved for patients with any of the following: A very large prostate (75 g), Concomitant bladder stones or bladder diverticula, Inability to be positioned for transurethral surgery. […] Patients with BPH who have symptoms significant enough to be placed on medication should be evaluated during office visits to discuss the efficacy of the medication and potential dose adjustment.

• #1 Benign prostatic hyperplasia (BPH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

  Your follow-up care will depend on the technique used to treat your enlarged prostate. […] Treatment for BPH has long been medications and procedures, such as lasers or an electric loop, which burn the prostate from the inside out. […] Dr. Kohler says the procedure, performed right in the doctor’s office, has a very low risk for complications or sexual side effects. […] Your Mayo Clinic care team will explain the range of treatments available and help you choose the best approach based on your symptoms.

• #1 Treating benign prostatic hyperplasia – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/mens-health-how-is-benign-prostatic-hyperplasia-treated

  If you’ve been diagnosed with benign prostatic hyperplasia (BPH) — noncancerous tissue growth within the prostate — it’s time for you and your health care team to talk about treatment options. These options depend on the severity of your symptoms, which can range from having a weak urine stream to not being able to urinate at all. Most treatments are done in the outpatient setting, including your provider’s office, while others may require a hospital stay. […] If these behavior modifications no longer work as effectively for you, your health care provider may prescribe a medication, which you’ll need to take every day. […] You and your health care team may decide that in-office therapies or surgery would be the best treatment option for you. They are done to shrink or remove overgrown prostate tissue. This can relieve bladder obstruction caused by an enlarged prostate.

• #2 Benign Prostatic Hyperplasia (BPH) Treatment & Management: Approach Considerations, Alpha-Blockers, 5-Alpha-Reductase Inhibitors

  https://emedicine.medscape.com/article/437359-treatment

  Therapeutic options for benign prostatic hyperplasia (BPH) include the following: Watchful waiting, Drug therapy (eg, alpha-blockers, 5-alpha-reductase inhibitors) for patients with bothersome, moderate-to-severe lower urinary tract symptoms (LUTS) from BPH, Interventional therapy (eg, transurethral resection of the prostate [TURP]) for patients with moderate-to-severe LUTS and those who have developed acute urinary retention or other complications of BPH. […] TURP has long been accepted as the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH. […] A guideline from the American Urological Association outlines clinical scenarios in which surgery is recommended for LUTS/BPH. The AUA guideline also suggests interventional techniques that can be used as alternatives to TURP.

• #2 BPH Treatment | Mount Sinai – New York

  https://www.mountsinai.org/care/urology/services/mens-health/bph/treatment

  Mount Sinai has extensive experience in treating benign prostatic hyperplasia (BPH). Once we diagnose this condition, we determine the most appropriate treatment, depending on how severe your symptoms are. […] Treatment options for lower urinary track symptoms (LUTS) include watchful waiting and progress through medical to surgical interventions. For the majority of patients their starting point on the treatment pathway will be dictated by their symptoms and degree of discomfort. […] If you are experiencing mild symptoms (IPSS ≤7) or moderate symptoms with minimal discomfort, your condition can be managed with watchful waiting. […] The aim of medical therapy is to improve your symptoms, lower the risk of progression and improve your quality of life. […] Alpha blockers, such as Flomax®, (tamsulosin) Cardura® (Doxazosin), and Hytrin® (Terazosin), work on the bladder neck (bladder opening) and prostatic urethra (area of the urethra surrounded by the prostate).

• #2 Benign Prostatic Hyperplasia (BPH) – familydoctor.org

  https://familydoctor.org/condition/benign-prostatic-hyperplasia-bph/

  Benign prostatic hyperplasia (BPH) is the medical term for an enlarged prostate. The condition affects the prostate gland in men. The enlargement isn’t caused by cancer or infection. […] Treatment for BPH depends on what symptoms you have and how severe they are. Options include lifestyle changes, medicine, minimally invasive procedures, and surgery. […] If your symptoms are mild or only slightly bothersome, you can usually control them with simple changes. These include: Reduce liquid intake, especially before bed or going out in public. Avoid caffeine, alcohol, and over-the-counter medicines that make you urinate more. Train your bladder to hold urine longer. Exercise your pelvic floor muscles. Prevent constipation. […] Your doctor can prescribe different medicines to treat BPH. Some of these improve urine flow or reduce blockages in the bladder. Others stop or shrink the growth of the prostate. Sometimes a combination of different medicines is used. Your doctor will recommend medicine based on your symptoms and condition.

• #2 Benign Prostatic Hyperplasia (BPH) Treatment & Management: Approach Considerations, Alpha-Blockers, 5-Alpha-Reductase Inhibitors

  https://emedicine.medscape.com/article/437359-treatment

  American Urological Association (AUA) guidelines advise that combination therapy with an alpha-blocker and a 5-alpha-reductase inhibitor can be appropriate and effective for patients with lower urinary tract symptoms (LUTS) who have enlarged prostates. […] Phosphodiesterase-5 (PDE5) inhibitors are known to mediate smooth muscle relaxation in the lower urinary tract. The long-acting PDE5 inhibitor tadalafil (Cialis) has been shown to be significantly better than placebo in improving the symptoms of BPH/LUTS. […] The American Urological Association BPH guidelines recommend anticholinergic agents for management of LUTS in patients who do not have an elevated PVR volume and whose LUTS are primarily irritative. […] A number of herbal formulations and plant-derived compounds have gained popularity worldwide for the management of BPH.

• #2 Medical Treatment of Benign Prostatic Hyperplasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3151584/

  Medical therapy for the treatment of benign prostatic hyperplasia (BPH) became an accepted standard of care in the 1990s following the reports of randomized, double-blind, placebo-controlled studies showing that finasteride, a 5- reductase inhibitor, and terazosin, an -blocker, significantly improved lower urinary tract symptoms and increased peak urinary flow rates in men with BPH. […] Over the following two decades, numerous randomized, placebo-controlled clinical trials have confirmed the effectiveness of two 5-ARIs (finasteride and dutasteride) and five -blockers (terazosin, doxazosin, tamsulosin, alfuzosin, and silodosin). […] The VA Cooperative Trial and the PREDICT trial unequivocally demonstrated there is no observed benefit of adding a 5-ARI to an -blocker to further decrease LUTS or increase peak urinary flow rate during the first year of treatment in unselected men with clinical BPH.

• #2 Benign Prostatic Hyperplasia (BPH): Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/benign-prostatic-hyperplasia-bph

  Various effective BPH treatments are available, including medications and minimally invasive surgery. The doctor will discuss the most suitable treatment option with you by considering your symptoms, prostate gland size, health conditions, and preferences. […] BPH treatments include medications and minimally invasive surgery. However, your most suitable treatment option depends on several factors, such as: […] Alpha-blockers: Help relax the bladder neck, and prostate muscles, facilitating urination. They include alfuzosin, doxazosin, tamsulosin, and silodosin. These medications work better for men with a relatively small prostate. However, side effects are dizziness and retrograde ejaculation, which is harmless. […] 5-alpha reductase inhibitors: These medications can shrink the size of the prostate by preventing hormonal change, which causes prostate growth. These medications are finasteride and dutasteride, requiring around six months for a noticeable outcome. The side effect is low sexual desire.

• #2 Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-basics/print

  The types of medicine used to treat BPH include alpha blockers, phosphodiesterase inhibitors, and alpha-reductase inhibitors. […] Alpha blockers are usually recommended as a first-line treatment for men with mild to moderate symptoms as they improve symptoms within days. […] Alpha-reductase inhibitors (also known as 5-alpha-reductase inhibitors or ARIs) are medicines that can stop the prostate from growing further or even cause it to shrink. […] A combination of an alpha blocker and an alpha-reductase inhibitor might be recommended for certain men. […] If medicines do not relieve your symptoms of BPH, a treatment to remove or destroy some of the prostate tissue around the urethra may be recommended. […] Several minimally invasive procedures are designed to treat prostate enlargement. […] Transurethral resection of the prostate (TURP) has been used extensively in the past and remains a common transurethral procedure for BPH. […] Other surgical procedures may be available for patients with BPH.

• #2 Newer Medications for Lower Urinary Tract Symptoms (LUTS) Associated with Benign Prostatic Hyperplasia (BPH) | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/prostatic-hyperplasia-medications/research-protocol

  Monotherapy with 5-ARI agents finasteride and dutasteride is another option for LUTS/BPH and BPE. Systematic reviews demonstrate that 5-ARIs are safe and effective and may be better than ABs in preventing disease progression (acute urinary retention and/or the need for surgical intervention). […] The AUA guideline also lists AB/5-ARI combinations as appropriate and effective treatment options for men with LUTS/BPH and prostate enlargement. The number of prescriptions for combination therapy (AB/5-ARI) increased after publication of the MTOPS trial (2003) showing better outcomes with the combination than with monotherapy. Comparative effectiveness for combined AB/5-ARI therapy is superior to monotherapy with either medication in men with LUTS/BPH and enlarged prostates with either agent are supported by systematic reviews.

• #2 Medical management of benign prostatic hyperplasia | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/3/163

  Inhibiting the conversion of testosterone to dihydrotestosterone with 5-alpha reductase inhibitors (5ARIs) can reduce prostate growth and tip the scales toward prostatic cellular apoptosis and atrophy. […] 5ARIs should be reserved for patients with BPH and lower urinary tract symptoms who have prostate glands 30 cc or larger or palpable prostatic enlargement on digital rectal examination. […] Phosphodiesterase-5 (PDE5) inhibitors increase intracellular cyclic guanosine monophosphate, causing nitric oxide-mediated relaxation of smooth muscle throughout the prostate, detrusor muscle (bladder), and urethra. […] Beta-3 agonists, including mirabegron and vibegron, work via the sympathetic pathway to cause relaxation of the detrusor muscle and increase bladder capacity. […] Combination pharmacotherapy has been shown to be more effective than monotherapy or placebo, specifically in patients with larger prostates who meet criteria for 5ARIs and can be offered alpha-blockers simultaneously. […] Several options exist for medical management of BPH, and choices are affected by indication, effectiveness, and side effects.

• #2 Benign Prostatic Hyperplasia (BPH) Treatment & Management: Approach Considerations, Alpha-Blockers, 5-Alpha-Reductase Inhibitors

  https://emedicine.medscape.com/article/437359-treatment

  TURP is considered the criterion standard for relieving BOO secondary to BPH. […] There is considerable interest in the development of other therapies to decrease the amount of obstructing prostate tissue while avoiding the above-mentioned adverse effects associated with TURP. […] Open prostatectomy is now reserved for patients with any of the following: A very large prostate (75 g), Concomitant bladder stones or bladder diverticula, Inability to be positioned for transurethral surgery. […] Patients with BPH who have symptoms significant enough to be placed on medication should be evaluated during office visits to discuss the efficacy of the medication and potential dose adjustment.

• #2 Enlarged Prostate (BPH) – Diagnosis and Treatment

  https://www.radiologyinfo.org/en/info/bph

  For surgery, there are many procedures to choose from, and the choice depends largely on your specific prostate anatomy, and surgeon preference and training. These procedures all have a common goal of widening the urethral channel as it passes through the prostate. […] Transurethral resection of the prostate (TURP): One of the more common surgical treatments for BPH, TURP involves the insertion of an instrument called a resectoscope through the urethra to remove the obstructing tissue, almost like removing the core from an apple, thus widening the channel. […] Laser surgery: When a TURP procedure is done with a laser instead of traditional removal of part of the prostate, the procedures are similar although differently named, depending on the type of laser used. […] Transurethral incision of the prostate (TUIP): In this procedure, the surgeon widens the urethra by making a few small incisions in the prostate gland and the neck of the bladder where it joins the urethra.

• #2 Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate – Urology | UCLA Health

  https://www.uclahealth.org/medical-services/urology/conditions-treated/male-conditions/benign-prostatic-hyperplasia-bph

  Transurethral resection of the prostate (TURP) has long been the mainstay of enlarged prostate surgery. […] An alternative to TURP is laser prostate surgery. […] One of the newest BPH surgeries offered at UCLA is Aquablation. […] Holmium laser enucleation of prostate (HoLEP) is an endoscopic surgery that is ideal for patients with very enlarged prostates. […] The UroLift System, approved by the U.S. Food and Drug Administration in 2013, is a minimally invasive approach to treating BPH and symptoms caused by an enlarged prostate. […] Rezum is a minimally invasive procedure that employs steam injected directly into the prostate to heat the prostatic tissue, ultimately leading to its destruction. […] The iTIND (Temporary Implanted Nitinol Device) procedure is geared toward patients with smaller prostates.

• #2 Considerations for Choosing Treatment Options for Benign Prostatic Hyperplasia – European Medical Journal

  https://www.emjreviews.com/urology/article/considerations-for-choosing-treatment-options-for-benign-prostatic-hyperplasia-j180121/

  Management options for BPH include conservative management, pharmacological treatment, and surgical interventions. […] Surgical procedures for BPH/LUTS are also classified based on their level of invasiveness into invasive surgical therapies (e.g., TURP, simple prostatectomy) or MIST. […] Emerging MIST interventions include prostatic artery embolisation; transurethral water vapour therapy (Rezum); other forms of interstitial ablation using transurethral and transperineally delivered laser energy; mechanical therapies such as the temporary implantable nitinol device (iTIND; Olympus Medical Systems, Tokyo, Japan), ClearRing (ProArc Medical, Pardes Hanna-Karkur, Israel), ZenFlow Spring (ZenFlow, San Francisco, California, USA), Butterfly (Butterfly Medical Ltd., Yokneam, Israel), and high-frequency ultrasound (histotripsy).

• #2 Overview of treatments for Benign Prostatic Hyperplasia (BPH) – Prostate Matters

  https://prostatematters.co.uk/determining-suitable-bph-treatment-options/overview-of-treatments-for-benign-prostatic-hyperplasia-bph/

  Some of the treatments available have lots of high-quality randomised evidence supporting them and some do not. […] The classic procedure here is the bladder neck incision or prostatotomy which has traditionally been carried out by either one or two cuts in the prostate using an electric knife under general anaesthetic. […] The iTIND is a new device which looks a little like the cage on a champagne cork and which is placed into the prostate under local anaesthetic. […] The UroLift procedure has gained attraction over the last 5-6 years and is essentially a device which allows quilting stitches to be placed in the front of the prostate, giving an anterior prostate channel (the anterior urethral lift) and is a simple procedure, carried out usually under light anaesthesia or IV sedation although some centres have had success with local anaesthetic.

• #2 Enlarged prostate: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000381.htm

  The choice of which surgical procedure is recommended is most often based on the severity of your symptoms and the size and shape of your prostate gland. Most men who have prostate surgery have improvement in urine flow rates and symptoms. […] Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece. […] Simple prostatectomy: This is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands. […] Other less-invasive procedures use heat or a laser to destroy prostate tissue. Another less-invasive procedure works by „tacking” the prostate open without removing or destroying tissues. None have been proven to be better than TURP. People who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for: Younger men, Older people, People with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease, Men who are taking blood-thinning medicines, Men who are otherwise at an increased surgical risk.

• #2 New BPH treatment ablates the prostatic tissue without heat – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/urology/news/new-bph-treatment-ablates-the-prostatic-tissue-without-heat/mac-20573532

  Benign prostatic hyperplasia (BPH) is one of the most common diagnoses in men over the age of 50. […] Initial treatments often include behavioral modifications and medications, but if these fail to improve symptoms, then surgery is the next best option. […] The goal of a BPH surgery is to open the prostatic urethra to allow for a stronger urinary stream and to help facilitate complete bladder emptying. […] The best surgical option is often individualized for each patient depending on the prostate size, symptom severity and patient priority in terms of sexual function preservation. […] Meghan A. Cooper, D.O., a urology consultant at Mayo Clinic in Rochester, Minnesota, brought Aquablation to the practice to treat this niche area within the BPH population. „We’re excited to offer this new surgical BPH option to our patients, and we’ve seen a large influx of patients who are looking specifically for this treatment,” says Dr. Cooper.

• #2 Benign Prostatic Hyperplasia (BPH) Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

  Clinicians should offer one of the following alpha blockers as a treatment option for patients with bothersome, moderate to severe LUTS/BPH: alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin. […] 5-ARIs alone or in combination with alpha blockers are recommended as a treatment option to prevent progression of LUTS/BPH and/or reduce the risks of urinary retention and need for future prostate-related surgery. […] Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. […] TURP should be offered as a treatment option for patients with LUTS/BPH.

• #2 Treatment Options for Enlarged Prostate (BPH) | Brown University Health

  https://www.brownhealth.org/be-well/treatment-options-enlarged-prostate-bph

  You dont have to live with an enlarged prostate and its symptoms. Selecting the most appropriate treatment for BPH involves careful consideration of individual symptoms, overall health, and personal preferences. Whether opting for medications, minimally invasive procedures, or surgery, the goal is to improve a mans quality of life by addressing urinary symptoms and restoring normal function.

• #2 Considerations for Choosing Treatment Options for Benign Prostatic Hyperplasia – European Medical Journal

  https://www.emjreviews.com/urology/article/considerations-for-choosing-treatment-options-for-benign-prostatic-hyperplasia-j180121/

  Preservation of sexual function is viewed as an important patient consideration when selecting treatment options for BPH, and interventions such as PUL, Rezum, and Aquablation have reported lower rates of sexual dysfunction relative to TURP, the current gold standard surgical intervention for BPH. […] PUL is currently the only leading MIST that offers rapid, significant, and durable symptom relief of LUTS due to BPH without causing new, sustained erectile dysfunction or ejaculatory dysfunction.

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