Abstract

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• The management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia over the last decade underwent many changes. The introduction of many medical options including alpha blockers and 5 alpha reductase inhibitors provided alternatives to what used to be surgery or "watchful waiting". Alpha blockers evolved over the years from non specific alpha 1, and 2 blockers to alpha 1 selective and then to alpha 1a selective with a wider acceptance due to lack of need to titrate and a better safety profile. 5 alpha reductase inhibitor (finasteride) passed through a lot of changes from being the first medication directed at treating the disease process to less acceptance because of time to response and early data supporting no added benefit when combined to alpha blockers for a short period. Longer studies now demonstrate a benefit to combination causing a reduction of progression parameters and an advantage over 4 years in reducing endpoints, namely acute urinary retention and surgery. Surgical options have also undergone many changes over the last decade with introduction of minimally invasive options as well as the introduction of new energy sources to reduce complications and allow for management of larger glands such as Holmium laser enucleation of the prostate or the use of bipolar loops. The journey has been long and exciting and we are sure Ernie Ramsey enjoyed being in the forefront of the evolution.