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Medical Therapy for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms.

Alexis E Te1, Ashwin Ramaswamy1, Steven A Kaplan1

  • 1Department of Urology, The Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Place, Box 1272, New York, NY 10029 USA.

The Urologic Clinics of North America
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Summary

Benign prostatic hyperplasia (BPH) treatments have advanced for lower urinary tract symptoms (LUTS). Combination therapy is optimal for men with moderate-to-severe BPH and enlarged prostates.

Keywords:
5-Alpha reductase inhibitorsAlpha-1 adrenergic receptor antagonistsBenign prostatic hyperplasiaCombination therapyLower urinary tract symptomsPhosphodiesterase-5 inhibitors

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Area of Science:

  • Urology
  • Geriatrics
  • Pharmacology

Background:

  • Benign prostatic hyperplasia (BPH) is highly prevalent in aging men.
  • Lower urinary tract symptoms (LUTS) are a primary manifestation of BPH.
  • Medical therapy is the established first-line treatment for BPH/LUTS.

Purpose of the Study:

  • To comprehensively review current medical therapies for BPH/LUTS.
  • To examine treatment mechanisms, efficacy, and patient selection.
  • To provide an evidence-based overview of BPH management.

Main Methods:

  • Literature review of pivotal clinical trials, systematic reviews, and treatment guidelines.
  • Search conducted for studies published between 2000 and 2024.
  • Focus on medical therapies for BPH and associated LUTS.

Main Results:

  • Medical therapy has evolved from symptom management to disease modification.
  • Combination therapy with alpha-1 adrenergic antagonists and 5-alpha reductase inhibitors is effective.
  • Optimal treatment involves combination therapy for moderate-to-severe symptoms and prostates ≥30 mL.

Conclusions:

  • Combination therapy represents the optimal medical approach for specific BPH patient groups.
  • Evidence supports a shift towards disease modification in BPH treatment.
  • Further research may refine patient selection for combination therapies.