Lower urinary tract symptoms suggestive of benign prostatic obstruction: what is the available evidence for rational management?

Because of the need for a more rational management of LUTS suggestive of BPO, EBM is receiving more attention. Treatment decisions should be based on scientific evidence more than on personal preferences of physicians and patients. EBM is more than following rigid treatment guidelines or published advice. It is a process of turning problems of clinical practice into well-defined questions and then finding and appraising available evidence and implementing it into clinical practice. In cases of LUTS suggestive of BPO, much evidence is available on the efficacy and tolerability of different treatment modalities in the short term, whereas long-term data on (cost)-effectiveness are rather scarce. From a patient's point of view, newer pharmacotherapeutic agents can be considered as an appropriate treatment option. alpha(1)-Adrenoceptor antagonists seem to be more efficacious than finasteride and within this group of drugs, selective alpha(1A)/alpha(1D)-adrenoceptor antagonists particularly show a favourable efficacy/tolerability ratio.