Medical therapy versus surgery and minimally invasive surgical therapies for lower urinary tract symptoms and benign prostatic hyperplasia: what makes better economic sense?

From a clinical standpoint, the emergence of selective pharmacologic therapies and minimally invasive procedural treatments has changed clinical management paradigms for benign prostatic hyperplasia (BPH). Choosing from among the available treatment options can be complex for both patient and physician as factors including clinical outcomes, cost, and reimbursement are weighed and evaluated. Pharmacologic therapies produce modest improvements in objective outcomes measures and subject patients to long-term costs and risks including disease progression and the potential need for subsequent procedural treatment. Procedural interventions for obstructive BPH have changed dramatically in the past several decades as minimally invasive therapies have been developed to produce substantial improvement in outcomes measures and limit the potential morbidity associated with traditional surgical therapies. This paper reviews the current literature to provide a framework for understanding the relationship between clinical outcomes and costs with respect to commonly used medical and procedural therapies for the management of symptomatic BPH and associated lower urinary tract symptoms. The objective is to provide the clinician with an assessment of peer-reviewed evidence-based data to facilitate informed decision making on patient treatment for obstructive BPH.