Open Access

ARTICLE

Benign prostatic hyperplasia and lower urinary tract symptoms: evidence and approaches for best case management

Jack Barkin

Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada
Address correspondence to Dr. Jack Barkin, Chief of Staff, Humber River Regional Hospital, 960 Lawrence Avenue West, Suite 404, Toronto, Ontario M6A 3B5 Canada

Canadian Journal of Urology 2011, 18(Suppl.2), 14-19.

Abstract

Significant lower urinary tract symptoms (LUTS) are very common in men over age 50. It is appropriate for the primary care physician to perform the work up to confirm that benign prostatic hyperplasia (BPH) is causing the LUTS. If the physician determines that the patient has moderate symptoms (an International Prostate Symptom Score [IPSS] ≥ 8), moderate “bother” (≥ 3 on the IPSS “bothersome index” question), and an enlarged (> 30 cc) prostate, then the most effective treatment is combination therapy with an alpha blocker and 5-alpha reductase inhibitor (5-ARI) at the time of confirmed BPH diagnosis. This combination will provide the most dramatic, early symptom response, the most sustained symptom response, and the most durable, reliable prevention of long term sequelae (acute urinary retention or the need for surgery), if the patient is compliant with taking the combination therapy.

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