A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE)
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BENIGN PROSTATIC HYPERPLASIA (K MCVARY, SECTION EDITOR)
A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE) Michelina D. Stoddard 1 & Ahra Cho 1 & Alexis E. Te 1 & Bilal Chughtai 1 Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes. Recent Findings The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. Summary To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention. Keywords Benign prostatic hyperplasia . Benign prostatic enlargement . Bladder outlet obstruction . Lower urinary tract symptoms . Delayed prostatectomy
Introduction Bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) is one of the most common causes of causes of lower urinary tract symptoms (LUTS) [1–8]. BPO occurs in instances of benign prostatic enlargement (BPE), which develops in patients with benign prostatic hyperplasia (BPH), a histologic description of the pathophysiologic process causing BPE [5, 9]. Clinically significant LUTS occurs in roughly 50% of men with BPE, of which approximately half of men develop by 50 years old [1–4, 6–8]. It is estimated that 75– 90% of men will have histologic evidence of BPH by the age of 80 [7]. The prevalence of LUTS due to BPE is expected to increase in the USA as the population ages [1, 8]. Untreated, BOO due to BPE can progress to more serious complications [1] such as urinary retention (UR) (0.5–3.3%) [10–13], hydronephrosis (5.8–6.9%) [11], urinary tract infection (UTI) (0.1–32.4%) [12–14], bladder calculi (0.4–15.6%) [10, 11, 14], and renal insufficiency (0.3–13.6%) [10, 11, 14, 15]. This article is part of the Topical Collection on Benign Prostatic Hyperplasia * Bilal Chughtai [email protected] 1
Weill Cornell Medicine, New York, NY 10065, USA
Generally, treatment is initiated after patients complain of LUTS. Multiple treatment options now exist for LUTS. Some patients with mild LUTS may see satisfactory improvement with conservative measures such as lifestyle modification and watchful waiting [10, 12, 15–17]. For patients with moderate to severe LUTS, medical therapy (α-blockers (α-Bs), 5-α reductase inhibitors (5-αRIs), etc.) is typically first-line intervention [16, 18, 19]. Medical treatment with either an α-B or a 5-αRI has been shown to improve LUTS and reduce the need for surgical intervention for LUTS due to BPE [2, 8, 12, 13, 15, 16, 18
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