Watchful Waiting (WW) is a viable option recommended for patients with minimal symptoms or moderate/severe symptoms with little impairment of quality of life. It is customary for this type of management to include the following components: education, reassurance, periodic monitoring and lifestyle advice.1
Patients managed by watchful waiting are monitored by their physician, but receive no active intervention for BPH unless symptoms worsen to a point where treatment is required. This approach will apply predominantly to men who have only mild symptoms (IPSS ³8) and prostates less than 30cc. However, watchful waiting may also be considered in patients with moderate symptoms (IPSS 9-19) where the patient does not have an enlarged prostate (<30cc) or that are not bothersome, and where the clinician believes active treatment is not essential. Patients themselves may choose not to pursue active therapy - they may want to avoid taking medication, or be influenced by the cost of treatment or the risks and inconvenience of surgery.
Initial follow-up in patients managed by watchful waiting should be at 6 months, and annually thereafter while symptoms remain stable.51 Other nonpharmacological strategies should be employed in conjunction with watchful waiting. These include lifestyle changes (such as a reduction in fluid, alcohol and caffeine intake), use of voiding schedules, and discontinuation and avoidance of drugs that may aggravate bladder outlet obstruction (such as anticholinergic and sympathomimetic drugs).
Additional Reference:
1. EAU BPH guidelines