What are the effects of treatment?

BENEFICIAL

Alpha Blockers

Systematic reviews have found that alpha blockers improve lower urinary tract symptom scores compared with placebo. Systematic reviews found limited evidence that different alpha blockers have similar effects. Randomized controlled trials (RCTs) found limited evidence that alpha blockers improved symptom scores compared with the 5-alpha reductase inhibitor finasteride. One RCT found no significant difference between tamsulosin and saw palmetto plant extracts in symptom scores or maximum flow rate after one year. Another RCT found limited evidence suggesting that alpha blockers were less effective than transurethral microwave thermotherapy in improving symptoms over 18 months. We found no RCTs comparing alpha blockers with surgical treatment.

5-Alpha Reductase Inhibitors.

One systematic review and additional RCTs have found that 5-alpha reductase inhibitors improve symptom scores and reduce complications compared with placebo. The review found that 5-alpha reductase inhibitors were associated with more adverse events than placebo, including decreased libido, impotence, and ejaculatory dysfunction. RCTs found limited evidence that the 5-alpha reductase inhibitor finasteride was less effective at improving symptom scores than alpha blockers. One systematic review found no significant difference in symptom scores between finasteride and saw palmetto plant extracts. We found no RCTs comparing 5-alpha reductase inhibitors with surgical treatment.

Saw Palmetto Plant Extracts

One systematic review has found that saw palmetto plant extracts improve symptom scores compared with placebo. It found no significant difference in symptom scores between saw palmetto plant extracts and the alpha blocker tamsulosin or the 5-alpha reductase inhibitor finasteride. One RCT found no significant difference in symptom scores between tamsulosin and tamsulosin plus saw palmetto plant extracts.

Transurethral Microwave Thermotherapy

RCTs found that transurethral microwave thermotherapy reduced symptom scores compared with sham treatment. We found limited evidence that thermotherapy was less effective in relieving short-term symptoms than transurethral resection. One RCT found that transurethral microwave thermotherapy improved symptom scores over 18 months compared with alpha blockers.

Transurethral Resection Versus No Surgery

RCTs found that transurethral resection reduced symptom scores more than watchful waiting and did not increase the risk of erectile dysfunction or incontinence.

LIKELY TO BE BENEFICIAL

Beta-Sitosterol Plant Extract

One systematic review has found that beta-sitosterol plant extract improves lower urinary tract symptom scores compared with placebo in the short term. We found no RCTs comparing beta-sitosterol plant extract with other treatments.

UNKNOWN EFFECTIVENESS

Pygeum Africanum

One systematic review found limited evidence that P. africanum increased peak urinary flow and reduced residual urine volume at four to 16 weeks compared with placebo. We found no RCTs comparing P. africanum versus other treatments.

Rye Grass Pollen Extract

One systematic review found limited evidence that rye grass pollen extract increased self-rated improvement and reduced nocturia at 12 to 24 weeks compared with placebo. However, the review identified only two small RCTs, from which we were unable to draw reliable conclusions. We found no RCTs comparing rye grass pollen extract with other treatments.

Transurethral Resection Versus Less Invasive Surgical Techniques

RCTs found no significant difference in symptom scores between transurethral resection and transurethral incision or between transurethral resection and electrical vaporization. RCTs found limited evidence that transurethral resection improved symptom scores more than visual laser ablation but that transurethral resection may be associated with a higher risk of blood transfusion.

Transurethral Resection Versus Transurethral Needle Ablation

One RCT found that transurethral resection reduced symptom scores compared with transurethral needle ablation after one year, although transurethral needle ablation caused fewer adverse effects.

Definition

Benign prostatic hyperplasia is defined histologically. Clinically, it is characterized by lower urinary tract symptoms (urinary frequency, urgency, a weak and intermittent stream, needing to strain, a sense of incomplete emptying, and nocturia) and can lead to complications, including acute urinary retention.

Incidence/Prevalence

Estimates of the prevalence of symptomatic benign prostatic hyperplasia range from 10 to 30 percent for men in their early 70s, depending on how benign prostatic hyperplasia is defined.¹

Etiology/Risk Factors

The mechanisms by which benign prostatic hyperplasia causes symptoms and complications are unclear, although bladder outlet obstruction is an important factor.² The best documented risk factors are increasing age and normal testicular function.³

Prognosis

Community- and practice-based studies suggest that men with lower urinary tract symptoms can expect slow progression of the symptoms.^4,5 However, symptoms can wax and wane without treatment. In men with symptoms of benign prostatic hyperplasia, rates of acute urinary retention range from 1 to 2 percent a year.^5–7