Minimally invasive therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia.

摘要

The last 15 years have brought significant changes in the management of lower urinary tact symptoms (LUTS) presumably secondary to benign prostatic hyperplasia. These changes are highlighted in 3 articles in this issue of The Journal (pages 1030, 1036 and 1047). Most patients are started on medical therapy with the majority receiving a-blocker therapy alone or in combination with 5a-reductase inhibitors. Other combinations including anti-muscarinics for predominantly storage symptoms as well as, more recently, the possibility of a-blockers plus phosphodi-esterase type 5 inhibitors to treat LUTS and erectile dysfunction are being explored. The net result is that patients who were traditionally treated with transurethral prostatectomy much earlier are presenting after failure of medical therapy at an older age and with more comorbid factors, many are anticoagulated, and a large proportion has acute or chronic urinary retention. The prostate volume is also larger.