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  • Image not available. Although symptomatic benign prostatic hyperplasia (BPH) is rare in men younger than 50 years of age, it is very common in men 60 years and older because of androgen-driven growth in the size of the prostate. Symptoms commonly result from both static and dynamic factors.
  • Image not available. BPH symptoms may be exacerbated by medications, including antihistamines, phenothiazines, tricyclic antidepressants, and anticholinergic agents. In these cases, discontinuing the causative agent can relieve symptoms.
  • Image not available. Specific treatments for BPH include watchful waiting, drug therapy, and surgery.
  • Image not available. For patients with mild disease who are asymptomatic or have mildly bothersome symptoms and no complications of BPH disease, no specific treatment is indicated. These patients can be managed with watchful waiting. Watchful waiting includes behavior modification and return visits to the physician at 12-month intervals for assessment of worsening symptoms or signs of BPH.
  • Image not available. If symptoms progress to a moderate or severe level, drug therapy or surgery is indicated. Drug therapy with an α1-adrenergic antagonist is an interim measure that relieves voiding symptoms. In select patients with prostates of at least 40 g, 5α-reductase inhibitors delay symptom progression and reduce the incidence of BPH-related complications.
  • Image not available. All α1-adrenergic antagonists are equally effective in relieving BPH symptoms. Older second-generation immediate-release formulations of α1-adrenergic antagonists (e.g., terazosin, doxazosin) can cause adverse cardiovascular effects, mainly first-dose syncope, orthostatic hypotension, and dizziness. For patients who can not tolerate hypotensive effects of the second-generation agents, the third-generation, pharmacologically uroselective agents (e.g., tamsulosin, silodosin) are good alternatives. An extended-release formulation of alfuzosin, a second-generation, functionally uroselective agent, has fewer cardiovascular adverse effects than immediate-release formulations of terazosin or doxazosin; however, whether extended-release doxazosin, alfuzosin, or silodosin have the same cardiovascular safety profile as tamsulosin is unclear.
  • Image not available. 5α-Reductase inhibitors are useful primarily for patients with large prostates greater than 40 g who wish to avoid surgery and can not tolerate the side effects of α1-adrenergic antagonists. 5α-Reductase inhibitors have a slow onset of action, taking up to 6 months to exert maximal clinical effects, which is a disadvantage of their use. In addition, decreased libido, erectile dysfunction, and ejaculation disorders are common adverse effects, which may be troublesome problems in sexually active patients.
  • Image not available. Surgery is indicated for moderate to severe symptoms of BPH for patients who do not respond to or do not tolerate drug therapy or for patients with complications of BPH. It is the most effective mode of treatment in that it relieves symptoms in the greatest number of men with BPH. However, the two most widely used techniques, transurethral resection of the prostate and open prostatectomy, are associated with the highest rates of complications, including retrograde ejaculation and erectile dysfunction. Therefore, minimally invasive surgical procedures are often desired by patients. These relieve symptoms and are associated with a lower rate of adverse effects, but they have a higher reoperation rate than the gold standard procedures.
  • Image not available. Although widely used in Europe for treatment of BPH, phytotherapy should ...

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