Managing Recurrence of Benign Prostatic Hyperplasia in Elderly Patients

Q: Managing Recurrence of Benign Prostatic Hyperplasia in Elderly Patients

Hello： Patients with benign prostatic hyperplasia are often elderly. <br>During transurethral resection of the prostate (TURP), due to the patient's advanced age and compromised organ function, there is a possibility of experiencing complications during and after the surgery, suc

Recurrent symptoms after prostate enlargement surgery?

My father is currently 79 years old.
He underwent surgery for benign prostatic hyperplasia three years ago, and his post-operative condition was good.
However, starting last month, he has experienced occasional urinary difficulties and a feeling of abdominal distension.
After a follow-up examination, the doctor indicated that the benign prostatic hyperplasia has recurred and that another surgery is needed.
I would like to know if undergoing surgery at 79 years old poses any risks.
If surgery is not performed, what alternative treatments are available? Additionally, considering that he has slightly low blood pressure, is surgery advisable?

A-Ming, 80~89 year old female. Ask Date: 2005/10/03

Dr. Chen Xiuyi reply Urology

Hello: Patients with benign prostatic hyperplasia are often elderly.
During transurethral resection of the prostate (TURP), due to the patient's advanced age and compromised organ function, there is a possibility of experiencing complications during and after the surgery, such as stroke, heart attack, significant bleeding, electrolyte imbalances, and water intoxication.
Currently, these complications cannot be completely avoided in medical practice.
The decision to pursue surgical treatment or medication therapy must take into account the patient's overall health status, the effectiveness and side effects of the medication, and should ideally be discussed with the attending physician.
Sincerely, Dr.
Hsiu-Yi Chen, Urologist.

Reply Date: 2005/10/03

More Info

Managing benign prostatic hyperplasia (BPH) in elderly patients, particularly those who have previously undergone surgery, requires careful consideration of the patient's overall health, the severity of symptoms, and the potential risks associated with further surgical intervention. In your father's case, at the age of 79, it is understandable to have concerns about the necessity and safety of another surgery for BPH.

Understanding BPH and Its Management:
BPH is a common condition in older men, characterized by the enlargement of the prostate gland, which can lead to urinary symptoms such as difficulty urinating, increased frequency, and a sensation of incomplete bladder emptying. While surgical options, such as transurethral resection of the prostate (TURP), are effective in relieving symptoms, they are not without risks, especially in elderly patients who may have comorbidities.

Risks of Surgery in Elderly Patients:
At 79 years old, your father may face increased surgical risks due to factors such as:
1. Anesthesia Risks: Older adults may have a higher risk of complications from anesthesia, including respiratory issues and cardiovascular events.

2. Recovery Time: The recovery period may be longer for elderly patients, and they may be more susceptible to postoperative complications such as infections.

3. Comorbid Conditions: If your father has other health issues, such as low blood pressure, this could complicate both the surgery and recovery process.

Non-Surgical Treatment Options:
If surgery is deemed too risky, there are several non-surgical treatment options available for managing BPH:
1. Medications: Alpha-blockers (e.g., tamsulosin) can help relax the muscles around the prostate and bladder neck, improving urine flow. 5-alpha-reductase inhibitors (e.g., finasteride) can help shrink the prostate over time.

2. Lifestyle Modifications: Encouraging your father to make certain lifestyle changes can also help manage symptoms. This includes reducing fluid intake before bedtime, avoiding caffeine and alcohol, and practicing double voiding (urinating, then waiting a few moments and trying again).

3. Minimally Invasive Procedures: If medications are ineffective and surgery is too risky, there are minimally invasive procedures such as laser therapy or microwave therapy that can reduce prostate size with less risk than traditional surgery.

Monitoring and Follow-Up:
Regular follow-up appointments with a urologist are essential to monitor your father's condition. If symptoms worsen or significantly impact his quality of life, a reevaluation of treatment options may be necessary.
Conclusion:
In summary, while surgery for BPH can be effective, the risks associated with surgery in elderly patients must be weighed against the benefits. Given your father's age and health status, it may be prudent to explore non-surgical options first. Consulting with a urologist who specializes in geriatric care can provide valuable insights tailored to your father's specific situation. Ultimately, the goal is to manage symptoms effectively while minimizing risks to his overall health.

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