Benign Prostatic Hypertrophy

Benign prostate hypertrophy is a common age-related, nonmalignant adenomatous overgrowth of the peri-urethral prostate gland.29,30 As the lumen of the prostatic urethra narrows, urinary outflow is progressively obstructed. Symptoms include urgency, incomplete emptying, increased frequency, weak stream, hesitancy, overflow incontinence, nocturia; and, potentially, complete urinary retention.29,30 Patients with mild symptoms do not require treatment.

Patients with moderate to severe symptoms are managed by lifestyle modification, medications, and surgery.29,30 Lifestyle modifications include losing weight, decreasing evening fluid intake; avoiding alcohol, caffeine, or highly seasoned food; and limiting medications known to cause lower urinary tract symptoms (e.g., incomplete emptying) such as anticholinergic agents, antidepressants, antihistamines, sympathomimetic drugs, and opioid analgesics.29,30

Alpha1‑adrenergic receptor antagonists such as terazosin and tamsulosin, which cause smooth muscle relaxation in the prostatic urethra and bladder neck, are the first-line of treatment for moderate-to-severe symptoms.2,3,29,30 If monotherapy with an alpha1‑adrenergic receptor antagonist is not effective, a 5α‑reductase inhibitor (e.g., finasteride or dutasteride) that reduces testosterone-associated androgenic effects and gradually decreases prostatic volume is added to the regimen.2,3,29,30