Benign Prostatic Hyperplasia

Technically, BPH -> BPE -> BOO -> LUTS. BPH is a histologic diagnosis. Therefore, a patient presenting with LUTS may be secondary to BOO, caused by BPE from BPH.

Evaluation of LUTS, from Campbell's



Clinic tests

BPH Labs

Treatment of LUTS, from Campbell's

Non-Surgical Managment

Common BPH drugs

Drug Dosing Selective? Titration? Side effects
Terazosin (Hytrin) 2-5mg QHS No Yes dizziness (14-17%), asthenia (5-13%) headache (5-13%), hypotension (2%)
Doxazosin (Cardura) 2-8mg QHS dizziness (5%), headache (5%)
Alfuzosin (Uroxatral) 10mg QHS No dizziness (12%), asthenia (5%), hypotension (3%), CV effects (10%)
Tamsulosin (Flomax) 0.4-0.8mg QHS Yes (a1A) dizziness (3-15%), asthenia (24%), headache (5-16%), retrograde ejaculation (1-18%), CV effects (9%)
Silodosin (Rapaflo) 8mg QHS retrograde ejaculation (10-14%), dizziness (8%), headache (3%)
Finasteride (Proscar) 5mg daily Type 2 decreased libido (4-5%), ejaculatory dysfunction (4%), erectile dysfunction (6%), gynecomastia/breast tenderness (0.5-1%), cardiac failure (1%)
Dutasteride (Avodart) 0.5mg daily No (Type 1 + 2)
Tadalafil (Cialis) 5mg daily Yes No headache (13%), dyspepsia (7%), flushing (7%)

Conservative Management


5a reductase inhibitors


B3-Agonist - Mirabegron

Phosphodiesterase Type 5 inhibitors


Surgical Management

Indications for Surgery

Choosing the right surgery

Clinical scenario: patient with > 100g prostate, with(out) urinary retention, and no prior prostate cancer workup