Benign prostatic hyperplasia (BPH), a nonmalignant neoplasm of the prostatic epithelial
and stromal tissue, occurs commonly in elderly men. The “gold standard” of care for
symptomatic BPH has been and remains transurethral resection of the prostate. This
operation, however, like any surgical procedure, has associated morbidity and imposes
an appreciable expense on the health-care system; therefore, enthusiasm for the development
of medical therapies for the management of symptomatic BPH has been substantial. Currently,
practicing physicians have two types of medications for the treatment of symptomatic
BPH: 5α-reductase inhibitors and α-adrenergic antagonists. The former drugs inhibit
the conversion of testosterone to the potent prostatic androgen dihydrotestosterone.
As a result, the androgenic stimulation to the prostate gland is suppressed, and the
size of the prostate is decreased by approximately 25%. In some patients, this outcome
decreases the mechanical obstruction of the prostatic urethra and improves micturition.
α-Adrenergic antagonists decrease the smooth muscle tone of the bladder neck, prostatic
adenoma, and prostatic capsule. After these structures have been relaxed, resistance
to urine flow through the prostatic urethra can be decreased, and obstructive voiding
symptoms can be resolved. Although two distinctly different mechanisms are involved,
both types of medications are effective for treating BPH. Thus, in 1993, transurethral
resection of the prostate is no longer the only available therapeutic option. With
the advent of medical therapies, internists and primary-care physicians will have
more involvement in the care of patients with BPH than previously. Therefore, urologists
and nonurologists must work together to serve the needs of patients with prostatism.
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© 1993 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
