Medical treatment of LUTS/BPH

Several drug therapies are available for male patients with bothersome lower urinary tract symptoms. Monotherapy with α-blockers is a commonly used and effective treatment to quickly improve LUTS, quality of life, and Q max. The main differences among the drugs are in the profile of adverse events [AEs], with cardiovascular AEs less prevalent with uroselective drugs (and especially with the novel silodosin, which is the compound with the highest selectivity). Conversely, ejaculatory dysfunction is less prevalent with nonselective drugs. 5α-reductase inhibitors [5-ARIs], alone or in combination with α-blockers, might be offered to men who have moderate to severe LUTS and an enlarged prostate to reduce the risk of urinary retention and prostate-related surgery. Those patients with prevalent storage LUTS may have benefited from anticholinergics. The risk of urinary retention with that category of drugs is minimal if patients with a higher risk of bladder outlet obstruction are avoided (e.g., those with PVR >200 mL, Q max <5 mL/s, or history of prior retention). Finally, tadalafil 5 mg is effective in improving symptoms in patients with LUTS, with or without concomitant erectile dysfunction.