Male Lower Urinary Tract Symptoms: Is Surgery Always Necessary?

• Published in: Gerontology (Basel) 1998, Vol.44 (2), p.61-66
• Main Authors: Assassa, R.P., Osborn, D.E., Castleden, C.M.
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Biological and medical sciences; Decision Making; Enzyme Inhibitors - therapeutic use; Humans; Male; Medical sciences; Nephrology. Urinary tract diseases; Prostatic Diseases - drug therapy; Prostatic Diseases - surgery; Review; Tumors of the urinary system; Urinary Retention - drug therapy; Urinary Retention - surgery; Urinary tract. Prostate gland
• ISSN: 0304-324X; 1423-0003
• DOI: 10.1159/000021985

A transurethral resection of the prostate is a good operation to relieve bladder outflow obstruction and has a low incidence of complications. However, recent work suggests that many men with symptoms may not require an operation, and it can probably be delayed in a majority for many years. This may be particularly important in old and frail patients. Many men with outflow obstruction have irritative symptoms such as urgency, frequency and nocturia; these could be treated with anticholinergics, provided they have normal flow rates and small or absent residual urine volumes. Pharmacological treatment to relieve outflow obstruction is disappointing. There may be some benefit from α-adrenoreceptor antagonists, but the place for 5α-reductase inhibitors is still unsure. All drugs have side effects which are unacceptable in patients who are not bothered by their urinary symptoms and can wait for active treatment.