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 flowand interrupted voiding, are related to the outflow obstruction dueto the prostate itself through its mass and its tonus, while irritativesymptoms, mainly diurnal and nocturnal frequency and urgency, aremostly due to detrusor abnormality, and to some extent to centralnervous system disturbance.Prostatic outflow obstruction may be treated by alphablockerswhich reduce prostatic and bladder neck muscle tone, or by 5 alphareductaseinhibitors which reduce glandular volume. Irritativesymptoms may be treated by anti-muscarinic agents and at a lowerdegree by alphablockers. Plant extracts, which mechanism of actionremains unclear, namely serenoa repens and pygeum africanum, arewidely used in France.The place of instrumental alternatives remains to be determined butthese instrumental treatments can now be regarded as possible alternativesto long life medical treatment rather than alternatives to astandard surgical treatment.