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T
reatment
of
benign
prostatic
hyperplasia
R
ev
A
ssoc
M
ed
B
ras
2017; 63(2):95-99
95
GUIDELINES IN FOCUS
Treatment of benign prostatic hyperplasia
T
ratamento
da
hiperplasia
prostática
benigna
Authorship:
Brazilian Society of Urology (SBU)
Participants:
Ricardo Vita Nunes
1
, João Manzano
1
, José Carlos Truzzi
1
, Aguinaldo Nardi
1
,
Antonio Silvinato
1
, Wanderley Marques Bernardo
2
Final draft:
August 7, 2016
1
Sociedade Brasileira de Urologia (SBU)
2
Associação Médica Brasileira (AMB)
http://dx.doi.org/10.1590/1806-9282.63.02.95The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize
procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending
on the conditions and the clinical status of each patient.
G
rades
of
recommendation
and
levels
of
evidence
A:
Experimental or observational studies of higher con-
sistency.
B:
Experimental or observational studies of lower con-
sistency.
C:
Cases reports (non-controlled studies).
D:
Opinion without critical evaluation, based on consen-
sus, physiological studies or animal models.
O
bjective
To advise physicians on the most indicated therapeutic
possibilities that can improve the symptoms of the urinary
tract and the quality of life of the patient, as well as prevent
complications related to the evolution of benign pros-
tatic hyperplasia.
I
ntroduction
A significant proportion of men with benign prostatic
hyperplasia (BPH) do not require treatment. Such obser-
vation does not necessarily imply the absence of treatment.
We can achieve improvement of lower urinary tract symp-
toms (LUTS) by adopting some non-pharmacological
measures, such as reducing nocturnal water intake, reduc-
ing caffeine and alcohol consumption, and avoiding the
use of decongestants and antihistamines. Men with mild
or moderate urinary tract symptoms that have minimal
impact on quality of life are candidates for active monitor-
ing requiring annual reevaluation.
1
(
D
)
W
hat
are
the
therapeutic
possibilities
for medicines
that
improve
urinary
symptoms
and
prevent
complications
related
to
the
progression
of
benign
prostatic
hyperplasia
?
Search strategy
(Hyperplasia OR Benign Prostatic Hypertrophy OR BPH OR Prostatic
Hyperplasia) AND (Adrenergic alpha-1 Receptor Antagonists OR
Adrenergic alpha-2 Receptor Antagonists OR Adrenergic alpha-
Antagonist OR Adrenergic alpha Blockers OR 5-alpha Reductase
Inhibitors OR 5ARIs OR Muscarinic Antagonists OR Antimuscarinics
OR Phosphodiesterase 5 Inhibitor* OR Inhibitors, PDE-5 OR PDE5)
AND (Therapy/Narrow[filter] OR systematic[sb])
1
st
selection:
717
Main exclusion factors:
Non-epidemiological studies, studies not related
to PICO, duplicate studies, weak evidence strength (Oxford and GRADE),
articles in languages other than Portuguese, English or Spanish
2
nd
selection:
32
Phytotherapy
Due to the lack of scientific evidence, the systematic use
of herbal medicines, such as Saw palmetto (
Serenoa repens
)
extract, to treat BPH-associated LUTS (BPH-LUTS) is
not recommended.
2
(
A
) The PROCOMB trial showed
that the combination therapy of tamsulosin and phyto-
therapy based on
Serenoa repens
plus selenium and lyco-
pene was more effective in improving International
Prostate Symptom Score (I-PSS) than either therapy alone