When treating and managing<unk> , the aim is to prevent complications related to the disease and improve or relieve symptoms. Approaches used include lifestyle modifications, medications, and surgery. Lifestyle Lifestyle alterations to address the symptoms of<unk>  include physical activity, decreasing fluid intake before bedtime, moderating the consumption of alcohol and caffeine-containing products and following a timed voiding schedule. Patients can also attempt to avoid products and medications with anticholinergic properties that may exacerbate urinary retention symptoms of<unk> , including antihistamines, decongestants, opioids, and tricyclic antidepressants; however, changes in medications should be done with input from a medical professional. Physical activity Physical activity has been recommended as a treatment for urinary tract symptoms. A 2019 Cochrane review of six studies involving 652 men assessing the effects of physical activity alone, physical activity as a part of a self-management program, among others. However, the quality of evidence was very low and therefore it remains uncertain whether physical activity is helpful in men experiencing urinary symptoms caused by<unk> . Voiding position Voiding position when urinating may influence urodynamic parameters (urinary flow rate, voiding time, and post-void residual volume). A meta-analysis found no differences between the standing and sitting positions for healthy males, but that, for elderly males with lower urinary tract symptoms, voiding in the sitting position: * decreased the post void residual volume * increased the maximum urinary flow, comparable with pharmacological intervention * decreased the voiding time This urodynamic profile is associated with a lower risk of urologic complications, such as cystitis and bladder stones. Medications The two main medication classes for<unk>  management are alpha blockers and 5α-reductase inhibitors. Alpha blockers Selective α1-blockers are the most common choice for initial therapy. They include alfuzosin, doxazosin, silodosin, tamsulosin, terazosin, and naftopidil. They have a small to moderate benefit at improving symptoms. Selective alpha-1 blockers are similar in effectiveness but have slightly different side effect profiles. Alpha blockers relax smooth muscle in the prostate and the bladder neck, thus decreasing the blockage of urine flow. Common side effects of alpha blockers include orthostatic hypotension (a head rush or dizzy spell when standing up or stretching), ejaculation changes, erectile dysfunction, headaches, nasal congestion, and weakness. For men with LUTS due to an enlarged prostate, the effects of naftopidil, tamsulosin and silodosin on urinary symptoms and quality of life may be similar. Naftopidil and tamsulosin may have similar levels of unwanted sexual side effects but fewer unwanted side effects than silodosin. Tamsulosin and silodosin are selective α1 receptor blockers that preferentially bind to the α1A receptor in the prostate instead of the α1B receptor in the blood vessels. Less-selective α1 receptor blockers such as terazosin and doxazosin may lower blood pressure. The older, less selective α1-adrenergic blocker prazosin is not a first line choice for either high blood pressure or<unk><unk> ; it is a choice for patients who present with both problems at the same time. The older, broadly non-selective alpha blocker medications such as phenoxybenzamine are not recommended for control of<unk> . Non-selective alpha blockers such as terazosin and doxazosin may also require slow dose adjustments as they can lower blood pressure and cause syncope (fainting) if the response to the medication is too strong. 5α-Reductase inhibitors The 5α-reductase inhibitors finasteride and dutasteride may also be used in men with<unk> . These medications inhibit the 5α-reductase enzyme, which, in turn, inhibits production of DHT, a hormone responsible for enlarging the prostate. Effects may take longer to appear than alpha blockers, but they persist for many years. When used together with alpha blockers, no benefit was reported in short-term trials, but in a longer-term study (3–4 years) there was a greater reduction in<unk>  progression to acute urinary retention and surgery than with either agent alone, especially in people with more severe symptoms and larger prostates. Other trials have confirmed reductions in symptoms, within 6 months in one trial, an effect that was maintained after withdrawal of the alpha blocker. Side effects include decreased libido and ejaculatory or erectile dysfunction. The 5α-reductase inhibitors are contraindicated in pregnant women because of their teratogenicity due to interference with fetal testosterone metabolism, and as a precaution, pregnant women should not handle crushed or broken tablets. Phosphodiesterase inhibitors (PDE) A 2018 Cochrane review of studies on men over 60 with moderate to severe lower urinary tract symptoms analyzed the impacts of phosphodiesterase inhibitors (PDE) in comparison to other drugs. These drugs may improve urinary symptoms slightly and reduce urinary bother but may also cause more side effects compared to placebo. The evidence in this review found that there is probably no difference between PDE and alpha blockers, however when used in combination they may provide a greater improvement in symptoms (with more side effects). PDE also likely improves symptoms when used in combination with 5-alpha reductase inhibitors. Several phosphodiesterase-5 inhibitors are also effective, but may require multiple doses daily to maintain adequate urine flow. Tadalafil, a phosphodiesterase-5 inhibitor, was considered then rejected by NICE in the UK for the treatment of symptoms associated with<unk> . In 2011, the U.S. Food and Drug Administration approved tadalafil to treat the signs and symptoms of<unk> , and for the treatment of<unk>  and erectile dysfunction (ED), when the conditions occur simultaneously. Others Antimuscarinics such as tolterodine may also be used, especially in combination with alpha blockers. They act by decreasing acetylcholine effects on the smooth muscle of the bladder, thus helping control symptoms of an overactive bladder. Self-catheterization Intermittent urinary catheterization is used to relieve the bladder in people with urinary retention. Self-catheterization is an option in<unk>  when it is difficult or impossible to completely empty the bladder. Urinary tract infection is the most common complication of intermittent catheterization. Several techniques and types of catheter are available, including sterile (single-use) and clean (multiple use) catheters, but, based on current information, none is superior to others in reducing the incidence of urinary tract infection. Surgery Transurethral resection of the prostate (TURP) If medical treatment is not effective, surgery may be performed. Surgical techniques used include the following: * Transurethral resection of the prostate (TURP): the gold standard. TURP is thought to be the most effective approach for improving urinary symptoms and urinary flow, however, this surgical procedure may be associated with complications in up to 20% of men. Surgery carries some risk of complications, such as retrograde ejaculation (most commonly), erectile dysfunction, urinary incontinence, urethral strictures. * Transurethral incision of the prostate (TUIP): rarely performed; the technique is similar to TURP but less definitive. * Open<unk> tomy: not usually performed nowadays due to its high morbidity, even if results are very good. Other less invasive surgical approaches (requiring spinal anesthesia) include: * Holmium Laser Ablation of the Prostate (HoLAP) * Holmium Laser Enucleation of the Prostate (HoLeP) * Photoselective vaporization of the prostate (PVP). * Aquablation therapy: a type of surgery using water jet to remove<unk>  tissue. Minimally invasive procedures Some less invasive procedures are available according to patients' preferences and co-morbidities. These are performed as outpatient procedures with local anesthesia. *<unk>  artery embolization: an endovascular procedure performed in interventional radiology. Through catheters, embolic agents are released in the main branches of the<unk>  artery, in order to induce a decrease in the size of the prostate gland, thus reducing the urinary symptoms. * Water vapor thermal therapy (marketed as Rezum): This is a newer office procedure for removing prostate tissue using steam aimed at preserving sexual function. *<unk>  urethral lift (marketed as UroLift): This intervention consists of a system of a device and an implant designed to pull the<unk>  lobe away from the urethra. * Transurethral microwave thermotherapy (TUMT) is an outpatient procedure that is less invasive compared to surgery and involves using microwaves (heat) to shrink prostate tissue that is enlarged. * Temporary implantable nitinol device (TIND and iTIND): is a device that is placed in the urethra that, when released, is expanded, reshaping the urethra and the bladder neck. Alternative medicine While herbal remedies are commonly used, a 2016 review found the herbs studied to be no better than placebo. Particularly, several systematic reviews found that Saw palmetto extract from Serenoa repens, while one of the most commonly used, is no better than placebo in both symptom relief and decreasing prostate size. Other somewhat effective herbal medicines at improving urine flow include beta-sitosterol from Hypoxis rooperi (African star grass), pygeum (extracted from the bark of Prunus africana), pumpkin seeds (Cucurbita pepo) and stinging nettle (Urtica dioica) root. A systematic review of Chinese herbal medicines found that Chinese herbal medicine, either as monotherapy or an adjuvant therapy with Western medicine, was similar to either placebo or Western medicine in the treatment of<unk> . Chinese herbal medicine was found to be superior to Western medicine in improving quality of life and reducing prostate volume.
Benign prostatic hyperplasia
Prostate cancer
Chronic bacterial prostatitis
Heart failure
Acute prostatitis
Diabetes
Granulomatous prostatitis
Urinary bladder disease