From the Guidelines
There are currently no standard intravenous (IV) medication options specifically approved for the routine treatment of Benign Prostatic Hyperplasia (BPH). BPH is typically managed with oral medications such as alpha-blockers (tamsulosin, alfuzosin, doxazosin), 5-alpha reductase inhibitors (finasteride, dutasteride), phosphodiesterase-5 inhibitors (tadalafil), or combination therapy 1.
Key Points to Consider
- In acute urinary retention caused by BPH, IV fluids may be administered for supportive care while a urinary catheter is placed to relieve the obstruction.
- Some patients may receive IV antibiotics if there is a concurrent urinary tract infection.
- In perioperative settings for BPH surgeries, IV anesthetics and analgesics are used, but these are not treating the BPH itself.
- The lack of IV options for BPH makes physiological sense because BPH is a chronic condition requiring long-term management, and IV medications are generally reserved for acute conditions or situations where oral administration is not possible.
- Patients experiencing acute urinary retention from BPH should seek immediate medical attention for catheterization, followed by initiation of appropriate oral therapy and consideration of surgical options if medical management fails.
Treatment Approach
- According to the AUA guideline, physicians should prescribe an oral alpha blocker prior to a voiding trial to treat patients with AUR related to BPH 1.
- Patients newly treated for AUR with alpha blockers should complete at least three days of medical therapy prior to attempting trial without a catheter (TWOC) 1.
- Clinicians should inform patients who pass a successful TWOC for AUR from BPH that they remain at increased risk for recurrent urinary retention 1.
From the Research
Intravenous Medication Options for BPH
There are no intravenous (IV) medication options specifically mentioned for the treatment of Benign Prostatic Hyperplasia (BPH) in the provided studies.
Available Treatment Options
However, the following oral medication options are available for the treatment of BPH:
- Alpha-blockers: quickly and effectively decrease lower urinary tract symptoms (LUTS) and symptomatic disease progression 2, 3, 4, 5
- 5-alpha reductase inhibitors (5-ARIs): decrease prostate volume, improve LUTS and urinary flow rates, and reduce the risk of acute urinary retention (AUR) and BPH-related surgery 2, 6, 3, 4
- Phosphodiesterase type 5 inhibitors (PDE5-Is): an alternative to alpha-blockers, especially when men experience bothersome side effects from alpha-blockers or erectile dysfunction 2
- Muscarinic receptor antagonists: a viable treatment option for patients with predominantly bladder storage symptoms and a small prostate 2
- Combination therapy: alpha-blocker plus muscarinic receptor antagonist, or 5-ARI plus alpha-blocker, can be more efficacious in reducing LUTS than single drugs alone 2, 6, 4
Key Considerations
When selecting a treatment option, considerations should include the patient's symptoms, prostate size, and potential side effects of the medication 2, 6, 3, 4, 5.