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BMJ. 2014 Aug 14;349:g4474. doi: 10.1136/bmj.g4474.

Lower urinary tract symptoms in men.

Author information

1
Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI, USA.
2
Minneapolis VA Center for Chronic Diseases Outcomes Research, Minneapolis, MN 55417, USA University of Minnesota School of Medicine, Minneapolis, MN, USA tim.wilt@va.gov.

Abstract

Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.

PMID:
25125424
PMCID:
PMC4688452
DOI:
10.1136/bmj.g4474
[Indexed for MEDLINE]
Free PMC Article

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