CURRENT TRENDS IN MANAGEMENT OF MEN WITH LOWER URINARY-TRACT SYMPTOMSAND BENIGN PROSTATIC HYPERPLASIA

Management of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has been central to urology for decades. The urolog ic community has increasingly come to realize that many men with LUTS do not have prostate enlargement and do not need their prostates debul ked surgically Of all the factors that have emerged to alter the trend s associated with management of LUTS and BPH, none has had more impact than the advent of medical therapy. The selective, long-acting, alpha (1)-blocking agents terazosin, doxazosin, and tamsulosin have become m ost popular because of their specificity in the urinary tract, reduced side effects, and simplicity of dosage. In addition, finasteride, a 5 -alpha-reductase inhibitor, was found to be effective in men with pros tates of greater than or equal to 40 g. Furthermore, the larger the pr ostate at baseline, the greater the efficacy of finasteride on symptom relief and flow rate improvement. In addition to medical therapy, an array of device therapies has emerged in the management of LUTS and BP H. Laser prostatectomy is the oldest of the device therapies and inclu des transurethral vaporization of the prostate (VLAP), transurethral e vaporation of the prostate (TUEP), and transurethral interstitial lase r prostatectomy (TILP). Studies report beneficial outcomes approaching those achieved with transurethral resection of the prostate (TURP) wi th less morbidity and a shorter hospital stay. Common diseases contrib ute the most to national healthcare expenditures. The management of LU TS and BPH are such disorders and result in the expenditure of vast he althcare resources worldwide. The surgical strategies have an establis hed record of outcomes documenting their potential for symptom relief and the avoidance of future complications. Medical and device therapie s, although currently promising and attractive, therefore must prove c omparable durability. (C) 1998, Elsevier Science Inc. All rights reser ved.