Long-term aspects of medical treatment of BPH

Acute urinary retention (AUR) is an important complication of benign prostatic hyperplasia (BPH) and can affect 0.4-25% of men seen in urological practice each year. AUR is also one of the main indications for surgery, being the presenting features of 25-30% of transurethral resection of the prostate (TURP). However, TURP conducted under these conditions is associated with higher morbidity. A number of risk factors for AUR have been identified including severity of LUTS, reduced peak flow rate, prostate volume, post-void residual volume (PVR) and old age. Medical therapy for BPH can impact on prostate size, increased PVR and previous AUR episodes. Finasteride has been shown to reduce prostate size and consequently reduce the risk of AUR. Studies on the alpha(1) blocker, alfuzosin, also report a reduced incidence of AUR compared with placebo. In addition, alfuzosin has proven effective in a trial without catheter in patients with AUR, thus potentially reducing the need for prostate surgery or allowing elective surgery to be conducted without preoperative catheterisation. Both options are highly beneficial to the patient.