Obstructive benign prostatic hyperplasia: therapeutical aspects

Once benign prostatic obstruction (BPO) is diagnosed, the urologist is confronted with an array of therapeutic modalities, from which he has to choose. The decision can be based on the patient's desire, deobstructing efficacy, durability, cost and on the physician's experience as well as availability of modalities.

A therapeutic spectrum is constructed for individualization of therapeutic options in evaluation of the relevant factors based on the published studies.

In treating BPO the surgical treatment (TURP, TUIP) is still the most reliable in experienced hands, and its cost-efficacy has to be weighed against durability. If LUTS without intravesical obstruction dominates, alpha-blocker or finasteride (prostates >40 g) are useful and more efficient than watchful waiting when symptom relief and uroflow improvement are outcome parameters. Interventional treatment modalities remain a moving target, since even high-energy TUMT does not overcome obstruction. Ablation techniques (Holmium laser, TEVAP) have not been used with regard to durability.

Picking an inappropriate modality or selecting the wrong patient may lead to a cascade of therapies. One can obtain a change in paradigms to measure the outcome putting emphasis on cost, need to retreat and, last but not least, quality of life.