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Benign prostatic hyperplasia: surgical versus nonsurgical treatment. A critical review.

With the advent of new treatments for benign prostatic hyperplasia (BPH), the urologist must objectively assess the results of new and traditional therapeutic options. This requires three sets of data-not all of which may be readily available-including a precise knowledge of the natural history of BPH; an objective assessment of the results of surgery, both open and transurethral; and an accurate estimate of objective and subjective results of medical treatment based on randomized studies with a placebo arm. The two types of medical treatment available are hormonal and neuropharmacologic manipulation. Hormonal treatment, using agents such as luteinizing hormone-releasing hormone agonists or antiandrogens, reduces the volume of the epithelial component of the prostate, but urodynamic improvement does not always parallel volumetric reduction. Neuropharmacologic treatment using alpha-blockers alone or in combination with anticholinergic agents has no effect on prostatic volume, but reduces the tone of the muscular component.