Treatment Decisions and Benign Prostatic Hyperplasia

Unfortunately, the progression of BPH cannot be predicted. Symptoms and objective measurements of urethral obstruction can remain stable for many years and may even improve over time in as many as a third of men. In a large evaluation of BPH treatments, called the Medical Therapy of Prostatic Symptoms (MTOPS) study, only 14 percent of untreated men in the placebo group experienced worsening symptoms during an average follow-up time of 4.5 years.

Men who eventually need treatment for BPH typically experience a progressive decrease in the size and force of their urinary stream or a sensation of incomplete emptying of their bladder. Although frequent nighttime urination is one of the most annoying symptoms of BPH, it does not predict the need for future treatment.

If urethral obstruction worsens and is left untreated, complications can occur. Potential complications include

  • thickened bladder with a reduced capacity to store urine
  • infected residual urine
  • bladder stones
  • a backup of pressure that damages the kidneys

Treatment decisions for BPH are based on the severity of symptoms as assessed by the International Prostate Symptom Score questionnaire, the extent of urinary tract damage, and the man's age and overall health.

In general, no treatment is needed for men who have only a few symptoms and are not bothered by them. Treatment—usually surgery—is required in the following situations:

  • kidney damage due to inadequate bladder emptying
  • a complete inability to urinate after treatment of acute urinary retention
  • incontinence due to overfilling or increased bladder sensitivity
  • bladder stones
  • infected residual urine
  • recurrent blood in the urine despite treatment with medication
  • symptoms that have not responded to medication and are troublesome enough to diminish quality of life

Treatment decisions are most difficult for men who have moderate symptoms (International Prostate Symptom Score of 8 to 19). Each of these men must determine whether the symptoms bother him enough, or interfere with his life enough, to merit treatment.

When selecting a treatment, both patient and doctor must weigh the effectiveness of various therapies against their side effects and costs.

Publication Review By: H. Ballentine Carter, M.D.

Published: 07 Apr 2011

Last Modified: 31 Aug 2015