Men with benign prostatic hyperplasia (BPH) frequently present with co-existing overactive bladder (OAB). When standard first-line pharmacotherapy no longer controls bothersome urinary symptoms, a structured next-step approach is needed.
This protocol applies to patients with benign prostatic hyperplasia together with overactive bladder whose symptoms persist or are inadequately managed despite an initial medication course.
Initial therapy — monotherapy with an antimuscarinic medication or a beta-3 agonist, or combination therapy with an alpha blocker plus an antimuscarinic medication or beta-3 agonist — did not achieve sufficient improvement in urinary frequency and urgency symptoms.
The structured protocol involves consideration of bladder outlet reduction — whether surgical or minimally invasive — tailored to the individual patient in the context of shared decision-making. The full sequence of options, selection criteria, and decision algorithm are in the complete protocol.
Clinicians should offer patients with BPH and OAB monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic medication or beta-3 agonist.
Clinicians may offer bladder outlet reduction surgeries for patients who present with LUTS and BPH.
The clinician may offer patients with BPH and bothersome OAB, in the context of shared decision-making, initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies.
There was also significant improvement in the subjective parameters of International Prostate Symptom Scores, frequency, urgency, nocturia, and urinary incontinence from baseline to both 3 and 6 months postoperatively in each of the three studied groups.
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