Changing approaches in the treatment of benign prostatic hyperplasia

A large number of new options for the management of benign prostatic hyperplasia (BPH) have become available, including several classes of drugs that are under investigation. Various principles of management include hyperthermia, balloon dilatation, the introduction of spirals to keep the prostate open, and exploitation of the endocrine dependence of BPH through androgen withdrawal, using 5 alpha-reductase and aromatase inhibition. The efficacy of these alternative forms of treatment will become better defined during the next few years. Whatever the result, it is likely that the indication for surgery will decrease. Therapy must also take into account the sexual activity and expectations of the patient, an area that until recently has been largely neglected.