Do Bedridden Elderly with Prostate Enlargement Need Ongoing Medication?

Do elderly patients with a history of benign prostatic hyperplasia still need medication treatment during their bedridden phase?

My father is 81 years old and suffered a brain injury in a car accident a year ago.
He is currently still unconscious, unable to speak, and is paralyzed and bedridden.
His medical history prior to the accident includes hypertension, diabetes, glaucoma, and benign prostatic hyperplasia (BPH).
Since the accident and being bedridden, he has not been taking medication for BPH.
I would like to consult a physician: Given that my father requires long-term use of adult diapers, will not continuing his BPH medication pose any risks?

A Q, 80~89 year old female. Ask Date: 2017/10/12

Dr. Liu Jiaju reply Urology

Benign prostatic hyperplasia (BPH) is considered a condition associated with longevity, and symptoms tend to worsen with age.
Unless you can confirm that your father's urination is normal and there are no issues with residual urine, continuing medication may be the better recommendation.

Reply Date: 2017/10/12

More Info

When considering the ongoing medication needs for a bedridden elderly patient with prostate enlargement, several factors must be taken into account, particularly in the context of your father's health status. Given that he is 81 years old, has a history of hypertension, diabetes, glaucoma, and prostate enlargement, and is currently bedridden due to a traumatic brain injury, the management of his prostate condition requires careful evaluation.

Prostate enlargement, or benign prostatic hyperplasia (BPH), is common in older men and can lead to urinary symptoms such as increased frequency, urgency, and difficulty in urination. In a bedridden patient, these symptoms can be exacerbated due to immobility and the potential for urinary retention, which can lead to complications such as urinary tract infections (UTIs) or bladder distension.
1. Need for Ongoing Medication: If your father has been previously treated for prostate enlargement, discontinuing medication may lead to worsening urinary symptoms. It is crucial to assess whether he is experiencing any urinary difficulties. If he is using adult diapers and has not been on medication for BPH, it is possible that he may experience increased urinary retention or discomfort. Medications such as alpha-blockers (e.g., tamsulosin) or 5-alpha-reductase inhibitors (e.g., finasteride) can help alleviate these symptoms by relaxing the bladder neck muscles or reducing prostate size, respectively.

2. Risks of Not Treating BPH: Without ongoing treatment, your father may face several risks. These include:
- Urinary Retention: This can lead to bladder overdistension, which may require catheterization.

- Urinary Tract Infections: Stagnant urine can increase the risk of infections, which can be particularly dangerous for elderly patients.

- Kidney Damage: Severe urinary retention can lead to back pressure on the kidneys, potentially causing renal impairment.

3. Assessment by a Healthcare Provider: It is essential to consult with a healthcare provider who can evaluate your father's current urinary function and overall health. They may recommend a urologist's assessment to determine if medication is necessary or if other interventions (such as catheterization) might be more appropriate given his current condition.

4. Monitoring and Adjustments: If medication is reintroduced, it is important to monitor for side effects, especially considering your father's other health conditions like hypertension and glaucoma. Some medications for BPH can affect blood pressure or interact with other medications he may be taking.

5. Quality of Life Considerations: Ultimately, the goal of any treatment should be to improve your father's quality of life. If urinary symptoms are causing discomfort or distress, addressing them through medication or other means is important.

In conclusion, while it may not be strictly necessary for your father to continue medication for prostate enlargement, the potential risks associated with untreated BPH in a bedridden patient warrant careful consideration. A thorough evaluation by a healthcare professional is essential to determine the best course of action tailored to your father's specific health needs. Regular follow-ups and adjustments to his treatment plan can help manage his condition effectively while minimizing complications.

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