OBJECTIVES: Urinary symptoms can be managed with antimuscarinics (AMs) and alpha-blockers (αBs). There is currently limited real-life data on the pharmacological management of men with BPH. The objective was to evaluate treatment patterns for BPH patients with predominant urgency and frequency symptoms in UK primary care. METHODS: Observational study of men ≥45 years whose recorded first diagnosis, symptom or therapy indicated BPH with predominant urgency and frequency between January 1,  2004 to September 30, 2011 in THIN UK primary care data. Treatment patterns were evaluated, including switching (>1 different αBs/AMs) and discontinuation (no αB/AM prescriptions during the last six months), from start of symptoms/treatment to end of records/symptoms resolved. RESULTS: Of 8694 men identified (mean age 66.41 years, standard deviation 10.38), the majority (90.29%) received αB during follow-up (median two years). Of these, 81.82% were prescribed tamsulosin, 16.36% alfuzosin, 10.79% doxazosin, (<3% others). Proportion of αB discontinuation varied slightly between first-line αBs: tamsulosin 38.27% (N=6,033); alfuzosin 41.10% (N=876); doxazosin 36.08% (N=679). 1,160 (14.78% of αB-treated men) received αB and AM prescriptions within 30 days of each other. Of 2167 (24.93%) men receiving AM, 40.98% were prescribed tolterodine, 37.19% oxybutynin, 35.67% solifenacin, (<7% others). Proportion of AM switching and discontinuation varied between first-line AMs: tolterodine 23.32% and 59.82% respectively (N=759); oxybutynin 24.60% and 54.70% (N=691); solifenacin 15.27% and 43.02% (N=537). Solifenacin had the highest average total duration of therapy, median 90 days (interquartile range [IQR] 30 to 300), tolterodine 56 (IQR 28 to 224) and oxybutynin 56 (IQR 30 to 146). CONCLUSIONS: The majority of men were treated with αBs, mostly tamsulosin, and a quarter received AMs. Of AMs, the higher duration and lower switch and discontinuation with solifenacin possibly reflect better tolerability profile and adherence to treatment. However, there may be confounding differences in patient characteristics which could be assessed in future research.