treatment of benign prostatic hyperplasia

Last edited 12/2018 and last reviewed 07/2021

Conservative management

  • if a man has post micturition dribble then should be told how to perform urethral milking

  • if storage LUTS (particularly urinary incontinence) then should be offered temporary containment products (for example, pads or collecting devices) to achieve social continence until a diagnosis and management plan have been discussed

  • if storage LUTS suggestive of overactive bladder (OAB) then should be offered supervised bladder training, advice on fluid intake, lifestyle advice and, if needed, containment products

  • supervised pelvic floor muscle training should be offered to men with stress urinary incontinence caused by prostatectomy
    • continue the exercises for at least 3 months before considering other options

  • refer for specialist assessment men with stress urinary incontinence

  • external collecting devices (for example, sheath appliances, pubic pressure urinals) should be offered for managing storage LUTS (particularly urinary incontinence) in men before considering indwelling catheterisation

  • intermittent bladder catheterisation should be offered before indwelling urethral or suprapubic catheterisation to men with voiding LUTS that cannot be corrected by less invasive measures

  • long-term indwelling urethral catheterisation should be considered for men with LUTS:
    • for whom medical management has failed and surgery is not appropriate and
    • who are unable to manage intermittent self-catheterisation or
    • with skin wounds, pressure ulcers or irritation that are being contaminated by urine or
    • who are distressed by bed and clothing changes

  • consider permanent use of containment products for men with storage LUTS (particularly urinary incontinence) only after assessment and exclusion of other methods of management

Drug treatment

  • offer drug treatment only to men with bothersome LUTS when conservative management options have been unsuccessful or are not appropriate
  • offer an alpha blocker (alfuzosin, doxazosin, tamsulosin or terazosin) to men with moderate to severe LUTS, especially if voiding type (hesitancy, poor stream)
  • offer a 5-alpha reductase inhibitor to men with LUTS who have prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml, and who are considered to be at high risk of progression (for example, older men)
  • consider offering a combination of an alpha blocker and a 5-alpha reductase inhibitor to men with bothersome moderate to severe LUTS and prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml
  • consider offering an anticholinergic as well as an alpha blocker to men who still have storage symptoms after treatment with an alpha blocker alone
  • consider offering a late afternoon loop diuretic to men with nocturnal polyuria
  • consider offering oral desmopressin to men with nocturnal polyuria if other medical causes have been excluded and they have not benefited from other treatments. Measure serum sodium 3 days after the first dose. If serum sodium is reduced to below the normal range, stop desmopressin treatment.