Editing Benign prostatic hyperplasia (section)

== Management ==
When treating and managing benign prostatic hyperplasia, the aim is to prevent complications related to the disease and improve or relieve symptoms.<ref name="Hwang_2018">{{cite journal | vauthors = Hwang EC, Gandhi S, Jung JH, Imamura M, Kim MH, Pang R, Dahm P | title = Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD007360 | date = October 2018 | pmid = 30306544 | pmc = 6516835 | doi = 10.1002/14651858.CD007360.pub3 }}</ref> Approaches used include lifestyle modifications, medications, catheterization, and surgery.

=== Lifestyle ===
[[File:NHS-thingstotry.png|alt=If you suffer symptoms, gradually train your bladder. Hold on when you need to pee and delay for longer each time. Do this slowly over several weeks. Try to pee in succession. This is where you wait a few moments after you have finished peeing and try again. It can help you empty your bladder properly. Use pads or a sheath to absorb leaks or dribbles. Pads can be worn inside underwear or replace underwear. Try to maintain a healthy weight. Being overweight can make your symptoms worse. If you have dribbling after peeing. Pelvic floor exercises can help. Manually push out the last few drops of urine (pee). After peeing, wait a few seconds, place your fingertips behind your scrotum, and gently massage forwards and upwards. Repeat twice.|thumb|Things that you can try if you have symptoms of an enlarged prostate, according to the NHS in England<ref name="www.england.nhs.uk" />.]]
[[File:NHS-thingstoavoid.png|alt=Drink fewer drinks with artificial sweeteners, and drink less alcohol. These can affect the bladder. Avoid caffeine completely. Caffeine can irritate the bladder lining which can make you want to pee urgently and cause leakage. It can take 4 – 6 weeks of completely avoiding caffeine to see a difference in symptoms. Fruit juices can sometimes make symptoms worse. This is because they are acidic and can irritate the bladder, especially if you have had prostate surgery. Avoid being constipated. It can put pressure on your bladder. Include fibre in your diet such as fruit, vegetables, beans, and whole grains. Avoid medicines with decongestants or antihistamines. These can make symptoms worse.|thumb|400x400px|Things to avoid if you have symptoms of an enlarged prostate, according to the NHS in England<ref name="www.england.nhs.uk" />.]]
Lifestyle alterations to address the symptoms of BPH include physical activity,<ref>{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 }}</ref> 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 BPH, including [[antihistamine]]s, [[decongestant]]s, [[opioid]]s, and [[tricyclic antidepressant]]s; however, changes in medications should be done with input from a medical professional.<ref>{{cite web |title = Benign prostatic hyperplasia |url = http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia |publisher = University of Maryland Medical Center |archive-url = https://web.archive.org/web/20170425092640/http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia |archive-date = 25 April 2017 }}</ref>

==== 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, and 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 benign prostatic hyperplasia.<ref>{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 | collaboration = Cochrane Urology Group }}</ref>

==== Voiding position ====
Voiding position when urinating may influence urodynamic parameters (urinary flow rate, voiding time, and post-void residual volume).<ref>{{cite web |url = http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf |title = Influence of voiding posture on urodynamic parameters in men: a literature review | vauthors = De Jong Y, Pinckaers JH, Ten Brinck RM, Lycklama à Nijeholt AA  |publisher = Nederlands Tijdschrift voor urologie |access-date = 2 July 2014 |url-status = live |archive-url = https://web.archive.org/web/20140714200739/http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf |archive-date = 14 July 2014}}</ref> 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-- <ref>{{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | date = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }}</ref>
* decreased the post-void residual volume;
* increased the maximum urinary flow, comparable with pharmacological intervention; and
* decreased the voiding time.

This [[Urodynamic testing|urodynamic]] profile is associated with a lower risk of urologic complications, such as [[cystitis]] and [[bladder stones]].

=== Medications ===
The two main medication classes for BPH management are [[alpha blocker]]s and [[5α-reductase inhibitor]]s.<ref>{{cite journal | vauthors = Silva J, Silva CM, Cruz F | title = Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard? | journal = Current Opinion in Urology | volume = 24 | issue = 1 | pages = 21–28 | date = January 2014 | pmid = 24231531 | doi = 10.1097/mou.0000000000000007 | s2cid = 40954757 }}</ref>

==== Alpha-blockers ====
[[Alpha-1 blocker|Selective α<sub>1</sub>-blockers]] are the most common choice for initial therapy.<ref name="Roehrborn2007">{{cite journal | vauthors = Roehrborn CG, Nuckolls JG, Wei JT, Steers W | title = The benign prostatic hyperplasia registry and patient survey: study design, methods, and patient baseline characteristics | journal = BJU International | volume = 100 | issue = 4 | pages = 813–819 | date = October 2007 | pmid = 17822462 | doi = 10.1111/j.1464-410X.2007.07061.x | hdl-access = free | s2cid = 21001077 | collaboration = BPH Registry and Patient Survey Steering Committee | hdl = 2027.42/73286 }}</ref><ref name="Black2006">{{cite journal | vauthors = Black L, Naslund MJ, Gilbert TD, Davis EA, Ollendorf DA | title = An examination of treatment patterns and costs of care among patients with benign prostatic hyperplasia | journal = The American Journal of Managed Care | volume = 12 | issue = 4 Suppl | pages = S99–S110 | date = March 2006 | pmid = 16551208 | url = http://www.ajmc.com/pubMed.php?pii=3096 }}</ref><ref name="Hutchison2007">{{cite journal | vauthors = Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV | title = The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries | journal = European Urology | volume = 51 | issue = 1 | pages = 207–15; discussion 215–6 | date = January 2007 | pmid = 16846678 | doi = 10.1016/j.eururo.2006.06.012 }}</ref> They include [[alfuzosin]],<ref name="MacDonald2005">{{cite journal | vauthors = MacDonald R, Wilt TJ | title = Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects | journal = Urology | volume = 66 | issue = 4 | pages = 780–788 | date = October 2005 | pmid = 16230138 | doi = 10.1016/j.urology.2005.05.001 }}</ref><ref name="Roehrborn2001">{{cite journal | vauthors = Roehrborn CG | title = Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial | journal = Urology | volume = 58 | issue = 6 | pages = 953–959 | date = December 2001 | pmid = 11744466 | doi = 10.1016/S0090-4295(01)01448-0 }}</ref> [[doxazosin]],<ref name="MacDonald2004">{{cite journal | vauthors = MacDonald R, Wilt TJ, Howe RW | title = Doxazosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects | journal = BJU International | volume = 94 | issue = 9 | pages = 1263–1270 | date = December 2004 | pmid = 15610102 | doi = 10.1111/j.1464-410X.2004.05154.x | s2cid = 6640867 | doi-access = free }}</ref> [[silodosin]], [[tamsulosin]], [[terazosin]], and [[naftopidil]].<ref name="Hwang_2018" /> They have a small to moderate benefit at improving symptoms.<ref name="Wilt_2003" /><ref name="Hwang_2018" /><ref name="Djavan1999">{{cite journal | vauthors = Djavan B, Marberger M | title = A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction | journal = European Urology | volume = 36 | issue = 1 | pages = 1–13 | year = 1999 | pmid = 10364649 | doi = 10.1159/000019919 | s2cid = 73366414 }}</ref> Selective alpha-1 blockers are similar in effectiveness but have slightly different side effect profiles.<ref name="Wilt_2003">{{cite journal | vauthors = Wilt TJ, Mac Donald R, Rutks I | title = Tamsulosin for benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002081 | date = 2003 | pmid = 12535426 | doi = 10.1002/14651858.CD002081 | veditors = Wilt T }}</ref><ref name="Hwang_2018" /><ref name="Djavan1999" /> 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]],<ref>{{cite journal | vauthors = Santillo VM, Lowe FC | title = Treatment of benign prostatic hyperplasia in patients with cardiovascular disease | journal = Drugs & Aging | volume = 23 | issue = 10 | pages = 795–805 | year = 2006 | pmid = 17067183 | doi = 10.2165/00002512-200623100-00003 | s2cid = 24428368 }}</ref> headaches, nasal congestion, and weakness. For men with [[Lower urinary tract symptoms|LUTS]] due to an enlarged prostate, the effects of naftopidil, tamsulosin, and silodosin on urinary symptoms and quality of life may be similar.<ref name="Hwang_2018" /> Naftopidil and tamsulosin may have similar levels of unwanted sexual side effects but fewer unwanted side effects than silodosin.<ref name="Hwang_2018" />

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 [[hypertension|high blood pressure]] or prostatic hyperplasia; 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 BPH.<ref name="pmid12853821">{{cite journal | title = AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations | journal = The Journal of Urology | volume = 170 | issue = 2 Pt 1 | pages = 530–547 | date = August 2003 | pmid = 12853821 | doi = 10.1097/01.ju.0000078083.38675.79 | author1 = AUA Practice Guidelines Committee }}</ref> Non-selective alpha-blockers such as terazosin and doxazosin may also require slow dose adjustments as they can lower blood pressure and cause [[syncope (medicine)|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 people with BPH.<ref name="Blankstein2016">{{cite journal | vauthors = Blankstein U, Van Asseldonk B, Elterman DS | title = BPH update: medical versus interventional management | journal = The Canadian Journal of Urology | volume = 23 | issue = Suppl 1 | pages = 10–15 | date = February 2016 | pmid = 26924590 | url = http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | url-status = live | archive-url = https://web.archive.org/web/20160807134146/http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | archive-date = 7 August 2016 }}</ref> These medications inhibit the [[5α-reductase]] enzyme, which, in turn, inhibits the production of [[Dihydrotestosterone|DHT]], a hormone responsible for enlarging the prostate. Effects may take longer to appear than alpha blockers, but they persist for many years.<ref name="Roehrborn2004">{{cite journal | vauthors = Roehrborn CG, Bruskewitz R, Nickel JC, McConnell JD, Saltzman B, Gittelman MC, Malek GH, Gottesman JE, Suryawanshi S, Drisko J, Meehan A, Waldstreicher J | title = Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia | journal = The Journal of Urology | volume = 171 | issue = 3 | pages = 1194–1198 | date = March 2004 | pmid = 14767299 | doi = 10.1097/01.ju.0000112918.74410.94 | collaboration = Proscar Long-Term Efficacy Safety Study Group }}</ref> 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 BPH progression to acute urinary retention and surgery than with either agent alone, especially in people with more severe symptoms and larger prostates.<ref>{{cite journal | vauthors = Roehrborn CG, Barkin J, Tubaro A, Emberton M, Wilson TH, Brotherton BJ, Castro R | title = Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study | journal = BJU International | volume = 113 | issue = 4 | pages = 623–635 | date = April 2014 | pmid = 24127818 | doi = 10.1111/bju.12500 | s2cid = 38243275 }}</ref><ref name="ReferenceB">{{cite journal | vauthors = Greco KA, McVary KT | title = The role of combination medical therapy in benign prostatic hyperplasia | journal = International Journal of Impotence Research | volume = 20  | issue = Suppl 3 | pages = S33–S43 | date = December 2008 | pmid = 19002123 | doi = 10.1038/ijir.2008.51 | doi-access = free }}</ref><ref name="pmid16406915">{{cite journal | vauthors = Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, Lee MW, Noble WR, Kusek JW, Nyberg LM | title = Combination therapy with doxazosin and finasteride for benign prostatic hyperplasia in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater | journal = The Journal of Urology | volume = 175 | issue = 1 | pages = 217–20; discussion 220–1 | date = January 2006 | pmid = 16406915 | doi = 10.1016/S0022-5347(05)00041-8 | collaboration = Medical Therapy of Prostatic Symptoms (MTOPS) Research Group }}</ref> Other trials have confirmed reductions in symptoms, within 6 months in one trial, an effect that was maintained after withdrawal of the alpha blocker.<ref name="ReferenceB" /><ref>{{cite journal | vauthors = Barkin J, Guimarães M, Jacobi G, Pushkar D, Taylor S, van Vierssen Trip OB | title = Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride | journal = European Urology | volume = 44 | issue = 4 | pages = 461–466 | date = October 2003 | pmid = 14499682 | doi = 10.1016/s0302-2838(03)00367-1 }}</ref> Side effects include decreased [[libido]] and ejaculatory or erectile dysfunction.<ref name = Gormley>{{cite journal | vauthors = Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, Andriole GL, Geller J, Bracken BR, Tenover JS | title = The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group | journal = The New England Journal of Medicine | volume = 327 | issue = 17 | pages = 1185–1191 | date = October 1992 | pmid = 1383816 | doi = 10.1056/NEJM199210223271701 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gacci M, Ficarra V, Sebastianelli A, Corona G, Serni S, Shariat SF, Maggi M, Zattoni F, Carini M, Novara G | title = Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis | journal = The Journal of Sexual Medicine | volume = 11 | issue = 6 | pages = 1554–1566 | date = June 2014 | pmid = 24708055 | doi = 10.1111/jsm.12525 }}</ref> 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.<ref>{{cite web | vauthors = Deters L |title = Benign Prostatic Hypertrophy Treatment & Management |url = http://emedicine.medscape.com/article/437359-treatment |website = Medscape |access-date = 14 November 2015 |url-status = live |archive-url = https://web.archive.org/web/20151030062812/http://emedicine.medscape.com/article/437359-treatment |archive-date = 30 October 2015}}</ref>
[[File:NHS-medicines-effectiveness.png|none|thumb|650x650px|The effectiveness of alpha-blockers and 5-ARIs, and a combination of the two, versus placebo pills, in improving symptoms of an enlarged prostate.<ref name="McConnell_2003">{{cite journal | vauthors = McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA | title = The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 349 | issue = 25 | pages = 2387–2398 | date = December 2003 | pmid = 14681504 | doi = 10.1056/NEJMoa030656 }}</ref><ref name="Roehrborn_2010">{{cite journal | vauthors = Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F | title = The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study | journal = European Urology | volume = 57 | issue = 1 | pages = 123–131 | date = January 2010 | pmid = 19825505 | doi = 10.1016/j.eururo.2009.09.035 }}</ref><ref name="Kaplan_2006">{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 }}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-medicines-sideeffects.png|none|thumb|676x676px|The frequency of side effects from alpha-blockers and 5-ARIs.<ref name="McConnell_2003" /><ref name="Roehrborn_2010" /><ref name="Kaplan_2006" /><ref>{{cite journal | vauthors = van Dijk MM, de la Rosette JJ, Michel MC | title = Effects of alpha(1)-adrenoceptor antagonists on male sexual function | journal = Drugs | volume = 66 | issue = 3 | pages = 287–301 | date = 2006-02-01 | pmid = 16526818 | doi = 10.2165/00003495-200666030-00002 }}</ref><ref>{{cite journal | vauthors = Descazeaud A, de La Taille A, Giuliano F, Desgrandchamps F, Doridot G | title = [Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia] | journal = Progres en Urologie | volume = 25 | issue = 3 | pages = 115–127 | date = March 2015 | pmid = 25605342 | doi = 10.1016/j.purol.2014.12.003 }}</ref><ref>{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk" />]]

====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 inhibitor]]s (PDE) in comparison to other drugs.<ref>{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 | collaboration = Cochrane Urology Group }}</ref> These drugs may improve urinary symptoms slightly and reduce urinary bother but may also cause more side effects than placebo. The evidence in this review found that there is probably no difference between PDE and [[alpha blocker]]s, however when used in combination they may provide a greater improvement in symptoms (with more side effects). PDE also likely improves symptoms when used with [[5-alpha reductase inhibitors]].

Several phosphodiesterase-5 inhibitors are also effective but may require multiple doses daily to maintain adequate urine flow.<ref>{{cite journal | vauthors = Wang Y, Bao Y, Liu J, Duan L, Cui Y | title = Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction: A Systematic Review and Meta-analysis | journal = Lower Urinary Tract Symptoms | volume = 10 | issue = 1 | pages = 84–92 | date = January 2018 | pmid = 29341503 | doi = 10.1111/luts.12144 | s2cid = 23929021 }}</ref><ref name="Pattanaik CD010060">{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 }}</ref> [[Tadalafil]], a phosphodiesterase-5 inhibitor, was considered then rejected by NICE in the UK for the treatment of symptoms associated with BPH.<ref name="guidance.nice.org.uk">{{cite web |title = Hyperplasia (benign prostatic) – tadalafil (terminated appraisal) (TA273) |url = http://guidance.nice.org.uk/TA273 |work = National Institute for Health and Clinical Excellence (NICE) |date = 23 January 2013 |access-date = 27 January 2013 |url-status = live |archive-url = https://web.archive.org/web/20130224050938/http://guidance.nice.org.uk/TA273 |archive-date = 24 February 2013}}</ref> In 2011, the U.S. Food and Drug Administration approved tadalafil to treat the signs and symptoms of benign prostatic hyperplasia, and for the treatment of BPH and erectile dysfunction (ED), when the conditions occur simultaneously.<ref name="fda.gov">{{cite web |title = FDA approves Cialis to treat benign prostatic hyperplasia |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |work = U.S. Food and Drug Administration (FDA) |access-date = 7 May 2013 |url-status = dead |archive-url = https://web.archive.org/web/20170118091151/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |archive-date = 18 January 2017}}</ref>

==== Others ====

[[Antimuscarinic]]s such as [[tolterodine]] may also be used, especially in combination with alpha-blockers.<ref name="Kaplan2006">{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 | doi-access = free }}</ref> They act by decreasing [[acetylcholine]] effects on the smooth muscle of the [[bladder]], thus helping control symptoms of an [[overactive bladder]].<ref>{{cite journal | vauthors = Abrams P, Andersson KE | title = Muscarinic receptor antagonists for overactive bladder | journal = BJU International | volume = 100 | issue = 5 | pages = 987–1006 | date = November 2007 | pmid = 17922784 | doi = 10.1111/j.1464-410x.2007.07205.x | s2cid = 30983780 | doi-access = free }}</ref>

=== Self-catheterization ===

Intermittent [[urinary catheterization]] is used to relieve the bladder in people with [[urinary retention]]. Self-catheterization is an option in BPH when it is difficult or impossible to empty the bladder.<ref>{{cite web|url=http://www.harvardhealthcontent.com/SpecialHealthReports/70,PA0212?Page=Section9|title=Prostate enlargement (benign prostatic hyperplasia)|website=Harvard Health Content|publisher=Harvard Health Publications|url-status=dead|archive-url=https://web.archive.org/web/20150403012629/http://www.harvardhealthcontent.com/SpecialHealthReports/70%2CPA0212?Page=Section9|archive-date=3 April 2015|access-date=2 February 2015}}</ref> [[Urinary tract infection]] is the most common complication of intermittent catheterization.<ref>{{cite journal | vauthors = Wyndaele JJ | title = Complications of intermittent catheterization: their prevention and treatment | journal = Spinal Cord | volume = 40 | issue = 10 | pages = 536–541 | date = October 2002 | pmid = 12235537 | doi = 10.1038/sj.sc.3101348 | doi-access = free }}<!--|access-date=2 February 2015--></ref> 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.<ref>{{cite journal | vauthors = Prieto JA, Murphy CL, Stewart F, Fader M | title = Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD006008 | date = October 2021 | pmid = 34699062 | pmc = 8547544 | doi = 10.1002/14651858.CD006008.pub5 }}</ref>

=== Surgery ===
{{Main|Surgery for benign prostatic hyperplasia}}

[[File:Rtu.jpg|thumb|right|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.<ref name="Franco_2021">{{cite journal | vauthors = Franco JV, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P | title = Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 6 | pages = CD004135 | date = June 2021 | pmid = 34180047 | pmc = 8236484 | doi = 10.1002/14651858.CD004135.pub4 }}</ref> 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.<ref name="Franco_2021" /> Surgery carries some risk of complications, such as [[retrograde ejaculation]] (most commonly), [[erectile dysfunction]], [[urinary incontinence]], [[urethral stricture]]s.<ref>{{Cite web|url=https://www.nhs.uk/conditions/transurethral-resection-of-the-prostate-turp/risks/|title=Transurethral resection of the prostate (TURP) - Risks|date=2017-10-24|website=nhs.uk|language=en|access-date=2020-03-08}}</ref>
* [[Transurethral incision of the prostate]] (TUIP): rarely performed; the technique is similar to TURP but less definitive.
* Open [[prostatectomy]]: not usually performed nowadays due to its high morbidity, even if the results are excellent.
Other less invasive surgical approaches (requiring [[Spinal anaesthesia|spinal anesthesia]]) include:
* [[Holmium laser ablation of the prostate]] (HoLAP)
* [[Holmium laser enucleation of the prostate]] (HoLeP)
* Thulium laser transurethral vaporesection of the prostate (ThuVARP)
* Photoselective vaporization of the prostate (PVP)
* [[Aquablation therapy]]: a type of surgery using a water jet to remove prostatic tissue.

=== Minimally invasive procedures ===
Some less invasive procedures are available according to patients' preferences and co-morbidities. These are performed as [[outpatient procedure]]s with [[local anesthesia]].
* [[Prostatic artery embolization]]: an endovascular procedure performed in [[interventional radiology]].<ref name="pmid28032133">{{cite journal | vauthors = Kuang M, Vu A, Athreya S | title = A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia | journal = CardioVascular and Interventional Radiology | volume = 40 | issue = 5 | pages = 655–663 | date = May 2017 | pmid = 28032133 | doi = 10.1007/s00270-016-1539-3 | s2cid = 12154537 }}</ref> Through [[catheter]]s, embolic agents are released in the main branches of the prostatic artery, in order to induce a decrease in the size of the prostate gland, thus reducing the urinary symptoms.<ref name="pmid27019980">{{cite journal | vauthors = Pisco J, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, Duarte M, Oliveira AG | title = Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms | journal = Journal of Vascular and Interventional Radiology | volume = 27 | issue = 5 | pages = 700–708 | date = May 2016 | pmid = 27019980 | doi = 10.1016/j.jvir.2016.01.138 }}</ref>
* [[Prostate steam treatment|Water vapor thermal therapy]] (marketed as Rezum): This is a newer office procedure for removing prostate tissue using steam aimed at preserving sexual function.
* [[Prostatic urethral lift]] (marketed as UroLift): This intervention consists of a system of a device and an implant designed to pull the prostatic lobe away from the urethra.<ref>{{cite journal | vauthors = McNicholas TA | title = Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system | journal =Medical Devices: Evidence and Research   | volume = 9 | pages = 115–123 | date = May 2016 | pmid = 27274321 | pmc = 4876946 | doi = 10.2147/MDER.S60780 | doi-access = free }}</ref>
* [[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.<ref name="Franco_2021" />
* [[Temporary implantable nitinol device]] (TIND and {{Proper name|iTIND}}): is a device that is placed in the urethra that, when released, is expanded, reshaping the urethra and the bladder neck.<ref>{{cite journal | vauthors = Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D | title = Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up | journal = BJU International | volume = 116 | issue = 2 | pages = 278–287 | date = August 2015 | pmid = 25382816 | doi = 10.1111/bju.12982 | hdl-access = free | s2cid = 5712711 | hdl = 2318/1623503 }}</ref>
[[File:NHS-surgeries-effectiveness.png|none|thumb|700x700px|The effectiveness of different surgeries and minimally-invasive procedures for enlarged prostate.<ref>{{cite journal | vauthors = Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, Schoenthaler M, Sonksen J | title = Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study | journal = BJU International | volume = 119 | issue = 5 | pages = 767–775 | date = May 2017 | pmid = 27862831 | doi = 10.1111/bju.13714 }}</ref><ref>{{cite journal | vauthors = Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J | title = The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial | journal = Urology | volume = 153 | pages = 270–276 | date = July 2021 | pmid = 33373708 | doi = 10.1016/j.urology.2020.12.022 }}</ref><ref name="Gilling_2019">{{cite journal | vauthors = Gilling PJ, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Roehrborn C | title = Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes | journal = Urology | volume = 125 | pages = 169–173 | date = March 2019 | pmid = 30552937 | doi = 10.1016/j.urology.2018.12.002 }}</ref><ref>{{Cite journal |date=September 2021 |title=Benign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09) |url=http://www.auajournals.org/doi/10.1097/JU.0000000000001982 |journal=Journal of Urology |language=en |volume=206 |issue=Supplement 3 |doi=10.1097/JU.0000000000001982 |issn=0022-5347}}</ref><ref>{{cite journal | vauthors = Cho SY, Park S, Jeong MY, Ro YK, Son H | title = 120W GreenLight High Performance System laser for benign prostate hyperplasia: 68 patients with 3-year follow-up and analysis of predictors of response | journal = Urology | volume = 80 | issue = 2 | pages = 396–401 | date = August 2012 | pmid = 22857762 | doi = 10.1016/j.urology.2012.01.063 }}</ref><ref name="Sievert_2019">{{cite journal | vauthors = Sievert KD, Schonthaler M, Berges R, Toomey P, Drager D, Herlemann A, Miller F, Wetterauer U, Volkmer B, Gratzke C, Amend B | title = Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years | journal = World Journal of Urology | volume = 37 | issue = 7 | pages = 1353–1360 | date = July 2019 | pmid = 30283994 | pmc = 6620255 | doi = 10.1007/s00345-018-2494-1 }}</ref><ref name="Sønksen_2015">{{cite journal | vauthors = Sønksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Montorsi F, Patterson JM, Fahrenkrug L, Schoenthaler M, Gratzke C | title = Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study | journal = European Urology | volume = 68 | issue = 4 | pages = 643–652 | date = October 2015 | pmid = 25937539 | doi = 10.1016/j.eururo.2015.04.024 | doi-access = free }}</ref><ref name="McVary_2016">{{cite journal | vauthors = McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, Rousseau M, Beahrs JR, Kaminetsky J, Cowan BE, Cantrill CH, Mynderse LA, Ulchaker JC, Larson TR, Dixon CM, Roehrborn CG | title = Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia | journal = The Journal of Urology | volume = 195 | issue = 5 | pages = 1529–1538 | date = May 2016 | pmid = 26614889 | doi = 10.1016/j.juro.2015.10.181 }}</ref><ref>{{cite journal | vauthors = Darson MF, Alexander EE, Schiffman ZJ, Lewitton M, Light RA, Sutton MA, Delgado-Rodriguez C, Gonzalez RR | title = Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezūm system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia | language = English | journal = Research and Reports in Urology | volume = 9 | pages = 159–168 | date = 2017-08-21 | pmid = 28861405 | pmc = 5572953 | doi = 10.2147/RRU.S143679 | doi-access = free }}</ref><ref>{{Cite journal |date=September 2021 |title=Benign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09) |url=http://www.auajournals.org/doi/10.1097/JU.0000000000001982 |journal=Journal of Urology |language=en |volume=206 |issue=Supplement 3 |doi=10.1097/JU.0000000000001982 |issn=0022-5347}}</ref><ref name="Campobasso_2023">{{cite journal | vauthors = Campobasso D, Siena G, Chiodini P, Conti E, Franzoso F, Maruzzi D, Martinelli E, Varvello F, De Nunzio C, Autorino R, Somani BK, Ferrari G, Cindolo L | title = Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study | journal = Prostate Cancer and Prostatic Diseases | volume = 26 | issue = 2 | pages = 410–414 | date = June 2023 | pmid = 36042295 | doi = 10.1038/s41391-022-00587-6 }}</ref><ref name="Bilhim_2022">{{cite journal | vauthors = Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E | title = Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period | journal = CardioVascular and Interventional Radiology | volume = 45 | issue = 9 | pages = 1324–1336 | date = September 2022 | pmid = 35778579 | doi = 10.1007/s00270-022-03199-8 }}</ref><ref>{{cite journal | vauthors = Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG | title = Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up | journal = European Radiology | volume = 23 | issue = 9 | pages = 2561–2572 | date = September 2013 | pmid = 23370938 | doi = 10.1007/s00330-012-2714-9 | hdl = 10400.17/1192 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M | title = Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis | journal = CardioVascular and Interventional Radiology | volume = 39 | issue = 1 | pages = 44–52 | date = January 2016 | pmid = 26506952 | doi = 10.1007/s00270-015-1202-4 }}</ref><ref name="Chughtai_2021">{{cite journal | vauthors = Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J | title = The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial | journal = Urology | volume = 153 | pages = 270–276 | date = July 2021 | pmid = 33373708 | doi = 10.1016/j.urology.2020.12.022 }}</ref><ref name="Rieken_2010">{{cite journal | vauthors = Rieken M, Ebinger Mundorff N, Bonkat G, Wyler S, Bachmann A | title = Complications of laser prostatectomy: a review of recent data | journal = World Journal of Urology | volume = 28 | issue = 1 | pages = 53–62 | date = February 2010 | pmid = 20052586 | doi = 10.1007/s00345-009-0504-z }}</ref><ref>{{cite journal | vauthors = Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park H | title = Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study | journal = Urology | volume = 154 | pages = 300–307 | date = August 2021 | pmid = 33933503 | doi = 10.1016/j.urology.2021.04.019 }}</ref><ref name="Gilling_2019" /><ref>{{cite journal | vauthors = Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, Shokeir AA | title = GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up | journal = European Urology | volume = 58 | issue = 3 | pages = 349–355 | date = September 2010 | pmid = 20605316 | doi = 10.1016/j.eururo.2010.05.026 }}</ref><ref name="Thomas_2016">{{cite journal | vauthors = Thomas JA, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A | title = A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study | journal = European Urology | volume = 69 | issue = 1 | pages = 94–102 | date = January 2016 | pmid = 26283011 | doi = 10.1016/j.eururo.2015.07.054 }}</ref><ref>{{cite journal | vauthors = Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC | title = Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety | journal = World Journal of Urology | volume = 39 | issue = 12 | pages = 4389–4395 | date = December 2021 | pmid = 33837819 | doi = 10.1007/s00345-021-03688-4 }}</ref><ref>{{cite journal | vauthors = Cindolo L, Ruggera L, Destefanis P, Dadone C, Ferrari G | title = Vaporize, anatomically vaporize or enucleate the prostate? 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|url=http://www.auajournals.org/doi/10.1097/JU.0000000000003299.13 |journal=Journal of Urology |language=en |volume=209 |issue=Supplement 4 |doi=10.1097/JU.0000000000003299.13 |issn=0022-5347}}</ref><ref name="Sievert_2019" /><ref name="Roehrborn_2016">{{cite journal | vauthors = Roehrborn CG | title = Prostatic Urethral Lift: A Unique Minimally Invasive Surgical Treatment of Male Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia | journal = The Urologic Clinics of North America | volume = 43 | issue = 3 | pages = 357–369 | date = August 2016 | pmid = 27476128 | doi = 10.1016/j.ucl.2016.04.008 | series = Treatment of Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia }}</ref><ref name="Sønksen_2015" /><ref>{{cite journal | vauthors = McNicholas TA, Woo HH, Chin PT, Bolton D, Fernández Arjona M, Sievert KD, Schoenthaler M, Wetterauer U, Vrijhof EJ, Gange S, Montorsi F | title = Minimally invasive prostatic urethral lift: surgical technique and multinational experience | journal = European Urology | volume = 64 | issue = 2 | pages = 292–299 | date = August 2013 | pmid = 23357348 | doi = 10.1016/j.eururo.2013.01.008 }}</ref><ref>{{Cite journal | vauthors = Loloi J, Wang S, Labagnara K, Plummer M, Douglass L, Watts K, Abraham N, Ohmann E |date=May 2024 |title=Predictors of reoperation after transurethral resection of the prostate in a diverse, urban academic centre |url=https://journals.sagepub.com/doi/10.1177/20514158221132102 |journal=Journal of Clinical Urology |language=en |volume=17 |issue=3 |pages=238–245 |doi=10.1177/20514158221132102 |issn=2051-4158}}</ref><ref>{{cite journal | vauthors = Guo S, Müller G, Lehmann K, Talimi S, Bonkat G, Püschel H, Gasser T, Bachmann A, Rieken M | title = The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study | journal = Lasers in Medical Science | volume = 30 | issue = 3 | pages = 1147–1151 | date = April 2015 | pmid = 25698433 | doi = 10.1007/s10103-015-1721-x }}</ref><ref>{{cite journal | vauthors = Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park H | title = Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study | journal = Urology | volume = 154 | pages = 300–307 | date = August 2021 | pmid = 33933503 | doi = 10.1016/j.urology.2021.04.019 }}</ref><ref name="Bilhim_2022" /><ref name="Ray_2018">{{cite journal | vauthors = Ray AF, Powell J, Speakman MJ, Longford NT, DasGupta R, Bryant T, Modi S, Dyer J, Harris M, Carolan-Rees G, Hacking N | title = Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study) | journal = BJU International | volume = 122 | issue = 2 | pages = 270–282 | date = August 2018 | pmid = 29645352 | doi = 10.1111/bju.14249 | doi-access = free }}</ref><ref name="Pisco_2013">{{cite journal | vauthors = Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG | title = Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up | journal = European Radiology | volume = 23 | issue = 9 | pages = 2561–2572 | date = September 2013 | pmid = 23370938 | doi = 10.1007/s00330-012-2714-9 | hdl = 10400.17/1192 | hdl-access = free }}</ref> Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-surgeries-effectiveness2.png|none|thumb|700x700px|The outcomes from different surgeries and minimally-invasive procedures for enlarged prostate.Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-surgeries-sideeffects.png|none|thumb|800x800px|Frequencies of side-effects from different surgeries and minimally-invasive procedures for enlarged prostate.<ref>{{cite journal | vauthors = Knight L, Dale M, Cleves A, Pelekanou C, Morris R | title = UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update | journal = Applied Health Economics and Health Policy | volume = 20 | issue = 5 | pages = 669–680 | date = September 2022 | pmid = 35843995 | pmc = 9385790 | doi = 10.1007/s40258-022-00735-y }}</ref><ref>{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}</ref><ref>{{cite journal | vauthors = Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, Gómez Rivas J, Dourado A, Veneziano D, Okhunov Z, Capogrosso P, Hueber PA, Alberseen M, Abreu A, Migliorini F, Fiori C, Porcaro AB, Porpiglia F, Desai M, Russo GI | title = Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials | journal = Minerva Urologica e Nefrologica = the Italian Journal of Urology and Nephrology | volume = 71 | issue = 5 | pages = 427–434 | date = October 2019 | pmid = 31487977 | doi = 10.23736/s0393-2249.19.03588-4 }}</ref><ref>{{cite journal | vauthors = Lokeshwar SD, Valancy D, Lima TF, Blachman-Braun R, Ramasamy R | title = A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH | journal = Current Urology Reports | volume = 21 | issue = 12 | pages = 54 | date = October 2020 | pmid = 33104947 | doi = 10.1007/s11934-020-01012-y }}</ref><ref>{{cite journal | vauthors = Calik G, Laguna MP, Gravas S, Albayrak S, de la Rosette J | title = Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint | journal = World Journal of Urology | volume = 39 | issue = 7 | pages = 2277–2289 | date = July 2021 | pmid = 33796882 | doi = 10.1007/s00345-021-03682-w }}</ref><ref name="Gilling_2019" /><ref name="Thomas_2016" /><ref>{{cite journal | vauthors = Kuntz RM, Ahyai S, Lehrich K, Fayad A | title = Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients | journal = The Journal of Urology | volume = 172 | issue = 3 | pages = 1012–1016 | date = September 2004 | pmid = 15311026 | doi = 10.1097/01.ju.0000136218.11998.9e }}</ref><ref name="Sønksen_2015" /><ref>{{cite journal | vauthors = Capitán C, Blázquez C, Martin MD, Hernández V, de la Peña E, Llorente C | title = GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up | journal = European Urology | volume = 60 | issue = 4 | pages = 734–739 | date = October 2011 | pmid = 21658839 | doi = 10.1016/j.eururo.2011.05.043 }}</ref><ref>{{cite journal | vauthors = Ghobrial FK, Shoma A, Elshal AM, Laymon M, El-Tabey N, Nabeeh A, Shokeir AA | title = A randomized trial comparing bipolar transurethral vaporization of the prostate with GreenLight laser (xps-180watt) photoselective vaporization of the prostate for treatment of small to moderate benign prostatic obstruction: outcomes after 2 years | journal = BJU International | volume = 125 | issue = 1 | pages = 144–152 | date = January 2020 | pmid = 31621175 | doi = 10.1111/bju.14926 }}</ref><ref>{{cite journal | vauthors = Krambeck AE, Handa SE, Lingeman JE | title = Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia | journal = The Journal of Urology | volume = 183 | issue = 3 | pages = 1105–1109 | date = March 2010 | pmid = 20092844 | doi = 10.1016/j.juro.2009.11.034 }}</ref><ref name="Rieken_2010" /><ref>{{cite journal | vauthors = Elshal AM, Soltan M, El-Tabey NA, Laymon M, Nabeeh A | title = Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo-enucleation of the prostate for treatment of large benign prostate obstruction: 3-years outcomes | journal = BJU International | volume = 126 | issue = 6 | pages = 731–738 | date = December 2020 | pmid = 32633020 | doi = 10.1111/bju.15161 }}</ref><ref>{{cite journal | vauthors = Geavlete B, Georgescu D, Multescu R, Stanescu F, Jecu M, Geavlete P | title = Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison | journal = Urology | volume = 78 | issue = 4 | pages = 930–935 | date = October 2011 | pmid = 21802121 | doi = 10.1016/j.urology.2011.03.072 }}</ref><ref>{{cite journal | vauthors = Rai 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Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA | title = 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study | journal = European Urology | volume = 65 | issue = 5 | pages = 931–942 | date = May 2014 | pmid = 24331152 | doi = 10.1016/j.eururo.2013.10.040 }}</ref><ref name="Roehrborn_2016" /><ref>{{cite journal | vauthors = Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, Schoenthaler M, Sonksen J | title = Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the 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February 2020 | pmid = 32065861 | url = https://www.canjurol.com/html/free-articles/Cdn_JU27_I1_05_FREE_DrGilling.pdf | publication-date = 2020 }}</ref><ref>{{cite journal | vauthors = Desai M, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Zorn KC | title = WATER II (80-150 mL) procedural outcomes | journal = BJU International | volume = 123 | issue = 1 | pages = 106–112 | date = January 2019 | pmid = 29694702 | doi = 10.1111/bju.14360 }}</ref><ref>{{Cite journal | vauthors = De Los Reyes TJ, Bhojani N, Zorn KC, Elterman DS |date=2020-09-01 |title=WATER II Trial (Aquablation) |url=https://link.springer.com/article/10.1007/s11884-020-00596-y |journal=Current Bladder Dysfunction Reports |language=en |volume=15 |issue=3 |pages=225–228 |doi=10.1007/s11884-020-00596-y |issn=1931-7220}}</ref><ref>{{cite journal | vauthors = Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D | title = Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up | journal = BJU International | volume = 116 | issue = 2 | pages = 278–287 | date = August 2015 | pmid = 25382816 | doi = 10.1111/bju.12982 | hdl = 2318/1623503 | hdl-access = free }}</ref><ref name="Chughtai_2021" /><ref>{{cite journal | vauthors = Elterman D, Alshak MN, Martinez Diaz S, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terens W, Kohan A, Gonzalez R, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu L, Kaminetsky J, Chughtai B | title = An Evaluation of Sexual Function in the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia in Men Treated with the Temporarily 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Graphic from NHS England.<ref>{{Cite web |title=NHS England » Decision support tool: making a decision about enlarged prostate (BPE) |url=https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-enlarged-prostate-bpe/ |access-date=2024-09-08 |website=www.england.nhs.uk}}</ref>]]

=== Alternative medicine ===
While [[herbal remedies]] are commonly used, a 2016 review found the herbs studied to be no better than [[placebo]]s.<ref>{{cite journal | vauthors = Keehn A, Taylor J, Lowe FC | title = Phytotherapy for Benign Prostatic Hyperplasia | journal = Current Urology Reports | volume = 17 | issue = 7 | pages = 53 | date = July 2016 | pmid = 27180172 | doi = 10.1007/s11934-016-0609-z | s2cid = 25609876 }}</ref> Particularly, several reviews found that [[saw palmetto extract]], while one of the most commonly used, is no better than a placebo both in symptom relief and in decreasing prostate size.<ref name="pmid16467543">{{cite journal | vauthors = Bent S, Kane C, Shinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins AL | title = Saw palmetto for benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 354 | issue = 6 | pages = 557–566 | date = February 2006 | pmid = 16467543 | doi = 10.1056/NEJMoa053085 | s2cid = 13815057 | doi-access = free }}</ref><ref name="pmid18423748">{{cite journal | vauthors = Dedhia RC, McVary KT | title = Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia | journal = The Journal of Urology | volume = 179 | issue = 6 | pages = 2119–2125 | date = June 2008 | pmid = 18423748 | doi = 10.1016/j.juro.2008.01.094 }}</ref><ref>{{cite journal | vauthors = Franco JV, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH | title = Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 6 | pages = CD001423 | date = June 2023 | pmid = 37345871 | pmc = 10286776 | doi = 10.1002/14651858.CD001423.pub4 }}</ref>