Benign Prostatic Hyperplasia

Page updated Winter 2021.

Disclaimer: Medicine is an ever-changing science. We have been witnessing changes in diagnostic and therapeutic modalities and guidelines during last several years. We have used sources believe to be reliable for purpose of this website including AUA guidelines, EAU guidelines, NCCN guidelines, Campbell-Walsh-Wein Urology, UpToDate, Merck Manual, Lexi-Comp, FDA website, and other reputable sources. However, due to possibility of human error or changes in medicine, readers are required to confirm the information provided in this website with other sources. Readers are specially required to read all parts of the product information sheet included in the package of each drug they plan to administer and follow those instructions. Readers are also needed to follow instructions of FDA and other regulatory bodies and their own department in this regard. Authors can cite information provided in our textbooks or they need to cite the original sources. This website serves as a general framework. We and other users would adjust the approach per departments policies and patients situation. Forms can be used by other health care professionals.

Medical Treatment of BPH

α1-blockers

Will be offered to men to with moderate-to-severe lower urinary tract symptoms (LUTS).

Currently available medications are: tamsulosin, silodosin, terazosin, doxazosin, and alfuzosin.

5α-reductase Inhibitors

Will be offered to men to with moderate-to-severe LUTS and a prostate volume > 40 mL.

Onset of action will be delayed for three to six months.

Currently available medications are: finasteride and dutasteride.


Muscarinic Receptor Antagonists

Will be offered to men with moderate-to-severe LUTS who mainly have bladder storage symptoms.

Will not be offered if post-void residual volume > 150 mL.

Currently available medications are:

oxybutynin, tolterodine, fesoterodine, solifenacin, darifenacin, propiverine, and trospium.

Phosphodiesterase Type 5 Inhibitors

Will be offered to men with moderate-to-severe LUTS with or without erectile dysfunction.

Currently available medications for this purpose: tadalafil


Beta-3 Agonists

Will be offered to men with moderate-to-severe LUTS who mainly have bladder storage symptoms.

Currently available medications: Mirabegron

Medical Treatment of BPH


α1 locker + a 5α-reductase Inhibitor


May be offered to men with moderate-to-severe LUTS and a prostate volume > 40 mL.


α1-blocker+ Muscarinic Receptor Antagonist


May be offered to men with moderate-to-severe LUTS if relief of storage symptoms has been insufficient with monotherapy with either drug.


Desmopressin


We may offer desmopressin to men men < 65 years who have nocturia due to nocturnal polyuria.


We may offer low dose desmopressin to men men > 65 years who have nocturia due to nocturnal polyuria.


Patients should avoid drinking fluids at least one hour before and eight hours after dosing.


Patient needs to be screened for hyponatremia at baseline, day three and day seven, one month after initiating therapy, and periodically during treatment. Na needs to be checked more frequently in high risk patients and in men > 65.


Surgical Treatment of BPH


Indications for Surgery


Lower urinary tract symptoms due to BPH refractory to other therapies


Refractory urinary retention secondary to BPH


Renal insufficiency secondary to BPH

Recurrent urinary tract infections


Recurrent bladder stones


Gross hematuria due to BPH


Surgical Treatment of BPH


Open, Laparoscopic or Robot Assisted Prostatectomy


If prostate size > 80 mL


TURP


Monopolar or bipolar TURP; if prostate is 30-80 mL.


TUIP


If prostate size <30 mL


TUVP


Bipolar; if prostate size is 30-80 mL


PVP


Photoselective Vaporization of the Prostate - Green light laser; 120W or 180W platforms; for patients with prostate size of 30-80 mL.


PUL


Prostatic Urethral Lift; If prostate size <80 mL and no obstructive middle lobe


TUMT


Transurethral Microwave Therapy ;If prostate size <80 mL and no obstructive middle lobe


Water Vapor Thermal Therapy


If prostate size <80 mL


Laser Enucleation


Holmium laser or thulium laser; size-independent


Aquablation


For patients with prostate size of 30-80 mL