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Benign Prostatic Hyperplasia
Treatment of Benign Prostatic Hyperplasia in the Geriatric Patient
Roberto Miano,
1
Cosimo De Nunzio,
2
Andrea Tubaro
2
and Anastasios Asimakopoulos
1
1. Division of Urology, Department of Surgery, Policlinico Tor Vergata, University ‘Tor Vergata’, Rome;
2. Department of Urology, Sant’Andrea Hospital, University ‘La Sapienza’, Rome
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men. Lower urinary tract symptoms (LUTS) are frequently
associated and often affect the individual’s quality of life. This article focuses on the different options for treating BPH in geriatric men. A
search of the literature was conducted in order to review the most relevant papers on the topic. Treatment options for BPH in older men
include medical therapy, transurethral resection of the prostate (TURP), transurethral microwave thermotherapy (TUMT), transurethral
needle ablation (TUNA), laser surgery and prostatic stenting. Many factors should be considered in choosing the appropriate treatment,
including age, individual anaesthesiological risk, LUTS, prostate volume, serum prostate-specific antigen (PSA), potential treatment-related
complications and presence of an indwelling catheter. Given the wealth of treatment options available, physicians must take care to choose
the right treatment for each patient, depending on individual needs and frailty.
Keywords
Benign prostatic hyperplasia (BPH), bladder outlet obstruction, lower urinary tract symptoms (LUTS), alpha-blockers, finasteride, transurethral
resection of the prostate (TURP), laser surgery, transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA),
prostatic stent
Disclosure: The authors have no conflicts of interest to declare.
Received: 31 May 2009 Accepted: 10 July 2009
Correspondence: Roberto Miano, Division of Urology, Department of Surgery, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy. E:
mianor@virgilio.it
Due to ongoing global fertility and greater life expectancy, an ageing geriatric patients, health risks must be weighted against the benefits,
population is expected to be one of the most prominent global taking into account several factors: age, individual anaesthesiological
demographic trends of the 21st century. The definition of ‘elderly’ or risk (influenced by co-morbidities or drugs), LUTS, prostate volume,
‘geriatric population’ may vary, but the typical cut-off is 65 years of serum total prostate-specific antigen (PSA), potential treatment-
age. Frailty, a complex biological phenomenon generally defined as a related complications and the presence of an indwelling catheter.
state of high vulnerability for adverse health outcomes, including
falls, hospitalisation, physical disability and mortality, is highly This article focuses on the different options for treating BPH in older
prevalent in old age:
1
the American Medical Association estimated men: watchful waiting, medical therapy, transurethral resection of the
that approximately 40% of persons ≥80 years of age are frail.
2
prostate (TURP), minimally invasive treatments and prostatic stenting.
Benign prostatic hyperplasia (BPH) is one of the most common Watchful Waiting
diseases in ageing men. It is frequently associated with bothersome The American Urological Association and the 5th International
lower urinary tract symptoms (LUTS) that affect the individual’s Consultation on BPH recommend watchful waiting for patients with
quality of life (QoL) and interfere with day-to-day activities. Moreover, mild symptoms or without bothersome LUTS who have not yet
BPH is a slowly progressing disease
3–6
defined as the result of developed serious complications.
7,8
symptomatic progression, the occurrence of acute urinary retention
(AUR), chronic renal failure or urinary tract infection (UTI) and the Medical Therapy
need for prostate surgery. Urologists should exercise caution when prescribing drugs to the
elderly because the downsides of drug use are magnified by the
Currently, when considering options for the management of LUTS sheer number of medications taken by this population, as well as their
that may suggest a bladder outflow obstruction due to BPH, the altered drug metabolism.
9
In fact, with ageing, physiological changes
short-term goal is to improve the individual’s QoL by relieving raise drug levels in the serum and cerebrospinal fluid, increasing the
symptoms such as nocturia, frequency and urgency. However, the risk of adverse events.
10
long-term goal should be to prevent or reduce the worsening of
symptoms over a long period of time, thereby eliminating serious Medical treatment options for LUTS/BPH include plant extracts,
complications such as AUR and avoiding or delaying the need for α1-adrenoceptor (AR) antagonists, 5α-reductase inhibitors and
prostatic surgery. At the same time, when choosing a treatment for combination therapy of an α1-AR antagonist and a 5α-reductase
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