Benign prostatic hyperplasia surgical

Describe the indications for surgical intervention of benign prostatic hyperplasia. 

Surgical intervention should be reserved for patients with severe lower urinary tract symptoms of benign prostatic hyperplasia or those with complications of disease (such as recurrent urinary tract infections, renal failure, and bladder calculi). 

Flanigan RC, Reda DJ, Wasson JHM, et al. 5 year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia a Department of Veterans Affairs cooperative study. J Urol 1998 160 12-17. 

Urethral overactivity and/or bladder underactivity is known as overflow incontinence. The bladder is filled to capacity but is unable to empty, causing urine to leak from a distended bladder past a normal outlet and sphincter. Common causes of urethral overactivity include benign prostatic hyperplasia (see Chap. 82) prostate cancer (see Chap. 65) and, in women, cystocele formation or surgical overcorrection after UI surgery. 

McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med 1998 338 557-563. 

In men, SUI is most commonly the result of prior lower urinary tract surgery or injury, with resulting compromise of the sphincter mechanism within and external to the urethra. Radical prostatectomy for treatment of adenocarcinoma of the prostate is probably the most common setting in which surgical manipulation leads to UI. Overall, SUI in the male is uncommon, and in the absence of prior prostate surgery, severe trauma, or neurologic illness, is extraordinarily rare. Transurethral resection of the prostate for benign prostatic hyperplasia (see Chap. 82) may also lead to SUI in men. 

A 74-year-old Caucasian man took tamsulosin for benign prostatic hyperplasia and after 8 days developed a right-sided lower lid entropion, which was successfully treated surgically. 

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