Benign prostatic hyperplasia (BPH) is a progressive disorder and a common occurrence in aging men, characterized by increased risk of acute urinary retention (AUR) and which may eventually require surgery due to enlargement of the prostate. The treatment of BPH is a choice between no treatment (watch-and-wait scenario), various surgical procedures, and pharmacotherapy in the majority of cases (>80%). Pharmacotherapy of BPH is based on two concepts, i.e. fi rstly, that alpha–adrenergic blockade reduces smooth muscle tone in the prostate and bladder neck, and secondly that 5 alpha–reductase inhibition causes atrophy of prostate epithelium. Studies have shown that both classes of drugs used as monotherapy produced improvements in patients symptoms. Combination therapy of those drugs is most appropriate in men who are symptomatic, are at high risk of progression of enlarged of prostate (EP), and produced improvements in patients with BPH (relief of voiding symptoms, improvement in urinary fl ow and quality of life). Surgical treatment should be considered for patients with progressive disease and complications of BPH, and who present worsening of symptoms not adequately controlled by medical therapy. This article discusses diagnosis and treatment strategies for BPH and proposes a practical algorithm for treatment based on available literature data and the author’s clinical experience.