Benign Prostatic Hyperplasia

Treatment of LUTS, from Campbell's

Non-Surgical Managment

Common BPH drugs

Drug Dosing Uro-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%)
Mirabegron (Myrbetriq) 25-50mg daily No No nasopharyngitis (3-6%), headache (2-3%), hypertension (10-12%)
Vibegron (Gemtesa) 75mg daily No No nasopharyngitis (3-6%), headache (2-3%)

Conservative Management


5a reductase inhibitors



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

  1. RALP may have increased risk for incontinence due to bladder neck reconstruction
  2. RALP age cutoff 70 (with exceptions), whereas RASP has no age cutoffs
  3. RASP + XRT may be better option for continence and prostate cancer than RALP
  4. MRI prostate, PSA, and biopsy will not change need for RASP (or other outlet procedure)
  5. Can perform biopsy at time of RASP
  6. Can consider XRT or other adjuvant therapies based on post-RASP PSA
  7. THEREFORE: in patient with 100+g prostate, can offer up-front RASP with truncated prostate cancer workup to avoid delaying treatment of urinary retention, but has risk of requiring XRT afterwards (difficult to perform RALP after RASP)