BENIGN PROSTATIC HYPERPLASIA OR BLADDER OUTFLOW OB

BENIGN PROSTATIC HYPERPLASIA OR BLADDER OUTFLOW OBSTRUCTION

Strong indications for treatment (usually prostatectomy) include: - /uni25CF Acute retention (see Chapter 83 ) in fit men with no other cause for retention (drugs, constipation, recent oper - ation, etc.) (accounts for 25% of prostatectomies). a residual urine of 200 /uni00A0 mL or more, hydroureter or hydronephrosis demonstrated on ultrasound, uraemic manifestations and abnormal renal function (accounts for 15% of prostatectomies). /uni25CF Complications of BOO : stone, infection and divertic ulum formation. /uni25CF Haemorrhage : these patients present with recurrent haematuria with no obvious cause and a very vascular prostate can be seen on cystoscopy . /uni25CF Elective prostatectomy for severe symptoms this accounts for about 60% of prostatectomies. Frequen cy alone is not a strong indication for prostatectomy . The natural progression of outflow obstruction is variable and rarely gets worse after 10 years. Severe symptoms not r esponding to drug therapy , a low maximum flow rate (<10 /uni00A0 mL/s) and an increased residual volume of urine (100–250 /uni00A0 mL) are relatively strong indications for opera tive treatment. Summary box 84.4 Options for treatment of LUTS secondary to BPH /uni25CF /uni25CF α α /uni25CF

Conservative measures include watchful waiting in conjunction with /f_l uid manipulation (avoid /f_l uid binge and late night intake) and a reduction in caffeinated and alcoholic drinks Drug therapy is with -blockers or, in men with a large prostate, a 5 -reductase inhibitor, or both; combination therapy has a better outcome in glands bigger than 35 /uni00A0 g Interventional measures include transurethral resection of the prostate (TURP), which remains the gold standard; consider HOLEP (holmium laser enucleation of the prostate), open/ robotic simple prostatectomy for large glands; new minimally invasive treatment options that are available to patients include prostate artery embolisation (PAE), water vapour prostate treatment (Rezu ¯ m), prostatic urethral lift (Urolift) and water jet treatment (Aquablation)