Lower urinary tract symptoms suggestive of benign prostatic hyperplasia: who are the high-risk patients and what are the best treatment options?

Purpose of review This review aims at giving a critical overview of the most recent publications on the diagnosis and treatment of high-risk patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Recent findings New risk factors such as dynamic variables, metabolic syndrome, or chronic prostatic inflammation have been recently investigated. Large prospective interventional studies have consistently provided new evidences of a benefit of the 5-alpha reductase inhibitors in reducing the risk of complication. Summary Despite the large number of risk factors that have been described, predicting the evolution and complication of lower urinary tract symptoms suggestive of benign prostatic hyperplasia remains challenging. Dynamic variables such as a previous acute urinary retention, a poor response to a medical therapy, a worsening of the symptom score, and a worsening of the postvoid residual are of additional value to the baseline variables. The metabolic syndrome and the chronic prostatic inflammation are also new fields of research providing new explanations on the physiopathology of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Treatment of high-risk patients should reduce the risk of complications. The 5-alpha reductase inhibitors and their combination with alpha-blockers have achieved this goal, but surgery should be considered as a first-line treatment in high-risk patients.