Pathogenesis and medical management of benign prostatic hyperplasia

This is simultaneously an exciting and confusing time for those caring for patients with BPH. For years we thought we had the answer, TURP, but costs and complications have opened this area for further study in alternative methods for the management of BPH. The pathogenesis and the maintenance of BPH is poorly understood and the natural history of BPH has not been well characterized. The bothersome level of symptoms to individual patients varies widely as well as the expectations of patients to the outcome of treatment. Satisfaction and cure are not necessarily identical, especially in patients with BPH, in which there seems to be great variability in the clinical course. Perhaps, in the future, this will be able to be related to the equally variable histological picture of BPH. There are problems in designing appropriate clinical trials for the evaluation of new treatments for BPH to take into account these variabilities in patient cases and histology (Table 9). The proper evaluation of new approaches to the management of patients with BPH takes years to complete, and physicians must resist the temptation to rush into any new treatment without reasonable caution for proven safety and efficacy when compared with existing modalities of treatment.