What is the treatment for difficulty urinating due to Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

Treatment for difficulty urinating due to Benign Prostatic Hyperplasia (BPH) typically begins with medication and lifestyle changes, progressing to surgical options if necessary. First-line medications include alpha-blockers like tamsulosin (Flomax) 0.4mg daily, which relax prostate and bladder neck muscles to improve urine flow, often providing relief within days to weeks 1. 5-alpha reductase inhibitors such as finasteride (5mg daily) or dutasteride (0.5mg daily) can shrink the prostate over 3-6 months by blocking testosterone conversion, and are effective in treating LUTS in men with probable benign prostate obstruction with gland enlargement 1. For men with larger prostates, combination therapy using both medication types may be more effective. Some key points to consider when treating BPH include:

• Lifestyle modifications, such as limiting evening fluid intake, avoiding caffeine and alcohol, and double-voiding (urinating, waiting a few minutes, then trying again) can help alleviate symptoms.
• If medications fail or symptoms are severe, surgical options include transurethral resection of the prostate (TURP), laser procedures, or minimally invasive treatments like UroLift.
• The choice of treatment should be based on the individual patient's symptoms, prostate size, and overall health, as well as the potential risks and benefits of each treatment option 1. It's also important to note that 5-alpha reductase inhibitors are not appropriate treatments for men with LUTS who do not have evidence of prostatic enlargement 1. Overall, the goal of treatment is to relieve symptoms, improve quality of life, and prevent complications, while also considering the potential risks and benefits of each treatment option.

From the FDA Drug Label

Finasteride tablets are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:

• Improve symptoms
• Reduce the risk of acute urinary retention
• Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.

The treatment for difficulty urinating due to Benign Prostatic Hyperplasia (BPH) is finasteride, which is used to improve symptoms, including those related to urinary retention and flow.

• Key benefits of finasteride include:
  • Reduction in the risk of acute urinary retention
  • Reduction in the need for surgery (such as TURP and prostatectomy)
  • Improvement in urinary flow rate
  • Reduction in prostate volume 2

From the Research

Treatment Options for Difficulty Urinating due to Benign Prostatic Hyperplasia (BPH)

The treatment for difficulty urinating due to BPH includes:

• Medical options such as 5alpha-reductase inhibitors (e.g., finasteride and dutasteride) and alpha1-adrenergic antagonists (e.g., doxazocin, terazosin, tamsulosin, and alfuzosin) 3
• Combination therapy of a 5alpha-reductase inhibitor and an alpha1-adrenergic antagonist, which can significantly reduce the clinical progression of BPH 3
• Tamsulosin, a subtype-selective alpha(1A)- and alpha(1D)-adrenoceptor antagonist, which has been shown to be effective in improving maximal urine flow and alleviating lower urinary tract symptoms (LUTS) in patients with BPH 4

Management of Acute Urinary Retention (AUR)

For patients with AUR, the immediate treatment is bladder decompression using urethral or suprapubic catheterization 5

• Alpha blockers, such as tamsulosin, can help prevent AUR in symptomatic BPH patients and facilitate catheter removal following episodes of spontaneous AUR 5
• Double dose alpha-blocker treatment (e.g., tamsulosin + alfuzosin) has been shown to be superior to single dose treatment in managing patients with AUR due to BPH, with a higher success rate in trial without catheter (TWOC) and reduced need for re-catheterization 6
• Tamsulosin has been shown to be effective in treating patients with AUR caused by BPH, with a higher success rate in voiding after catheter removal compared to placebo 7

Benefits and Side Effects of Treatment

The benefits of treatment include improved urine flow, alleviation of LUTS, and reduced risk of AUR and need for surgical intervention 3, 4, 5, 6, 7

• The side effects of treatment, such as dizziness, abnormal ejaculation, and hypotension, are generally mild and well-tolerated 4, 6, 7