Medical management of benign prostatic hyperplasia in the light of available evidence

Benign prostatic hyperplasia (BPH) is an age-related androgen dependent progressive disease. It is associated with bothersome lower urinary tract symptoms which prove detrimental to the quality of life for both the effected men and their partners. With an aging population elderly people constituting greater proportion of population, the prevalence of BPH is on the rise with a significant impact on medical sector. Initial investigations using simple diagnostic tools can be offered to the patient suspected of having BPH as first diagnostic step in primary care setting and can help in minimizing the delay in diagnosis and management. Due to extensive work done recently in understanding the natural history of BPH and the knowledge of physiological effects of various medical interventions has greatly helped us in choosing therapeutic options for individualized treatment. This has resulted inconsiderable reduction in the rate of transurethral prostatectomy seen during the last couple of decades. Development of adrenoceptor blockade and hormonal manipulation has moved increasing number of men away from surgery towards pure medical management of BPH. We reviewed the current status of medical management in light of the evidence in support of each agent, and the correct selection of treatment.