By Garrett D. Pohlman

Benign prostatic hyperplasia (BPH), otherwise known as an enlarged prostate, is a common condition that can affect a man’s quality of life and cause side effects such as the urgent need to urinate, nocturia (nighttime urination), bladder damage, urinary tract infections, blood in the urine, incontinence and more. The prevalence of BPH and lower urinary tract issues rises markedly with increased age, affecting 70% of men 60-69 years of age and 80% of those 70 years of age or older.

For many years, medication was the next step in the progression for treatment for BPH symptomsand is still widely used today, despite low efficacy and poor patient compliance. One might even say BPH medications only act as a Band-Aid for symptoms – though they may provide some symptom relief for some people, they don’t address the underlying cause of the issue – bladder obstruction. And in fact, long-term bladder outlet obstruction puts pressure on the bladder causing it to give out and may result in irreparable damage to the bladder. Thankfully for physicians and patients, and widely due to their demand for better treatment options, today there are a plethora of new and emerging minimally invasive treatment options that can be used alongside or in place of medication.

A brief historical overview of BPH medication usage
There are a few main categories of medications that have historically been used to treat BPH symptoms, including a1-blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors, Beta-3 agonists, Muscarinic receptor antagonists (MRAs) and combination therapy. Though these medications can be somewhat successful in providing symptom relief for some patients, they are also associated with a number of serious side effects like cardiovascular events (postural hypotension, asthenia and dizziness), ejaculatory dysfunction, decreased libido, gynecomastia, erectile dysfunction, acute urinary retention, urinary tract infection, hypertension, headache, constipation and nasopharyngitis (Frontiers in Pharmacology, 2020). Facing these side effects, along with difficulty maintaining proper medication adherence, patients have increasingly struggled to find true relief from BPH symptoms with medication.

Changing views on BPH medication use
In addition to the long list of potential side effects, there is also a growing body of research that supports shifting away from medications as a first-line treatment when comparing them to the efficacy and safety profiles of other options.

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