Conservative and pharmacological treatment of benign prostatic hyperplasia The German S2e-guideline 2023-part2

Background: Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH, in German guidelines: benign prostatic syndrome [BPS]) is considered the most common disease of the lower urinary tract in men and can have a tremendous impact on the quality-of-life of affected patients. Conservative and pharmacological therapy of this disease are of great importance, both in improving LUTS and reducing progression-related complications. Objectives: Presentation of the conservative and pharmacological treatment options according to the current German S2e guideline on BPS. Materials and methodsSummary and overview of chapters 9 and 10 of the current German S2e guideline on BPS. Results: In addition to a controlled watchful waiting for BPS patients without an absolute indication for prostate surgery, a variety of phytopharmacological formulations and synthetic drugs according to the symptomatology and clinical progress are available. Phytotherapy should, due to inconsistent study data, only be considered for mild to moderate symptoms. Synthetic drugs include alpha-blockers, 5 alpha-reductase inhibitors, phosphodiesterase inhibitors, antimuscarinics and, more recently, the beta 3-agonist mirabegron in the current guideline. In addition, various combination therapies are listed and evaluated according to their indications, effects and side effects. Conclusions: The current German S2e guideline on the diagnosis and treatment of BPS provides an evidence-based foundation for finding the best possible and most effective medication.