[Medical treatment of benign hypertrophy of the prostate]

Surgery is obviously indicated in a patient with benign prostatic hypertrophy and severe signs of urine retention, infection, and a bladder with diverticles and calculi. Inversely the patient with minor dysuria and a normal upper urinary tract usually needs simple counselling. The major question is how to manage patients with intermediary symptomatology. Much emphasis has been placed on measurement of quality of life, but cannot be used to determine a therapeutic strategy. Indeed, there is no precise criteria for indicating medical treatment of benign prostatic hypertrophy. Randomized, controlled and well conducted studies have shown however that the beneficial effect of certain drugs is greater than the placebo effect, but there is no common criteria to determine what degree of improvement justifies prescription. In addition, the cost of medical treatment, in terms of overall health care cost for the society, must be taken into consideration. Despite these drawbacks, several drug classes--plant extracts, alpha-blockers, 5-alpha-reductase inhibitors--have been used with confirmed effectiveness. The spectacular advances in pharmacology in the field of benign prostatic hypertrophy will undoubtedly have an impact on other areas of research, but the medical, economic and ethic justification of prescribing "comfort" drugs is one of the major challenges facing urologists today.