Medical treatment of benign prostatic hyperplasia and instrumental alternatives

Clinical symptoms related to benign prostatic hyperplasia (BPH) combine obstructive and irritative symptoms. Obstructive symptoms, associating at different levels hesitancy, straining, weak flow and interrupted voiding, are related to the outflow obstruction due to the prostate itself through its mass and its tonus, while irritative symptoms, mainly diurnal and nocturnal frequency and urgency, are mostly due to detrusor abnormality, and to some extent to central nervous system disturbance. Prostatic outflow obstruction may be treated by alphablockers which reduce prostatic and bladder neck muscle tone, or by 5 alphareductase inhibitors which reduce glandular volume. Irritative symptoms may be treated by anti-muscarinic agents and at a lower degree by alphablockers. Plant extracts, which mechanism of action remains unclear, namely serenoa repens and pygeum africanum, are widely used in France. The place of instrumental alternatives remains to be determined but these instrumental treatments can now be regarded as possible alternatives to long life medical treatment rather than alternatives to a standard surgical treatment.