[Epidemiology of BPH and medication approaches]

A more profound knowledge on the pathogenesis, the natural history and the risk of progression enablesa more differentiated therapy of elderly men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and benign prostatic enlargement as compared to 15 years ago. Phytotherapy is currently not recommended by any international BPH-guideline, because the definitive clinical proof for their clinical efficacy has not been made. alpha1-blockers and 5alpha-reductase inhibitors (5ARIs) are established world-wide. Alpha1-blockers are the medical therapy of choice for symptomatic patients with a low risk of clinical progression (e.g. prostate volume < 30-40 ml). Recent long-term data indicate that alpha1-blockers have no effect on the long-term risk of acute urinary retention and the risk of surgery. 5ARIs should be reserved for patients with a higher risk of progression (e.g. prostate volume > 30-40 ml). 5ARIs significantly reduce the risk of acute urinary retention and the need for surgery.