New frontiers in the treatment of benign prostatic hyperplasia: Advances in pharmacotherapy and surgical options
Abstract
A 72-year-old retired schoolteacher in Copenhagen once described his nightly routine: setting three alarms to remind himself to attempt voiding before his bladder discomfort became unbearable, a pattern that had persisted for over four years before he sought urological consultation. His experience captures the daily burden that benign prostatic hyperplasia imposes on millions of aging men around the world, and it was precisely such patient narratives that motivated this research. This prospective multicenter investigation compared the clinical effectiveness of contemporary pharmacotherapy regimens and minimally invasive surgical interventions for benign prostatic hyperplasia across 414 symptomatic men treated at two Danish academic urology departments between March 2020 and December 2021. Participants were allocated to one of seven treatment arms through shared clinical decision-making: alpha-adrenergic blockers alone, phosphodiesterase-5 inhibitors alone, 5-alpha reductase inhibitors alone, combination alpha-blocker plus 5-alpha reductase inhibitor therapy, transurethral resection of the prostate, water vapor thermal therapy (Rezum), and prostatic urethral lift (UroLift). Primary outcomes included International Prostate Symptom Score reduction, maximum urinary flow rate improvement, and complication rates assessed at 3, 6, and 12 months post-treatment initiation. Transurethral resection achieved the greatest symptom improvement with a mean International Prostate Symptom…
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