Management of non-complicated BPH: proposition of a renewed decision tree

Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. The standard medical treatments are represented by three families which are the phytotherapy, the alpha-blockers and the 5-alpha-reductase inhibitors. These treatments were deemed as symptomatic and used only as monotherapy. Recent numerous studies bring new assessments on BPH: the medical treatment is able to modify the natural history of BPH especially by reducing the risk of acute urinary retention. Furthermore the association of two different therapeutic classes seems to be more efficient than the use of a monotherapy in some cases. Similarly the place of two instrumental techniques, the thermotherapy by microwaves or by radiofrequencies, previously proposed as alternatives to the surgical treatment seems to find their way rather as alternatives to the medical treatment. These different elements allow building a renewed decision tree which decisions are shared with the patient at each stage. This decision tree of the management of patients having non-complicated BPH symptoms must include initial clinical characteristics of the patient and its disease and the evolution under treatment which has not been yet considered in the international recommendations. It also considers the possibilities of associations with other therapeutic classes.