Determining the Optimal Timing for Surgery in Benign Prostatic Hyperplasia

In the last few decades, the management of benign prostatic hyperplasia (BPH) has evolved notably. Medical therapy has become the main treatment choice, whereas surgery is mainly for patients who do not respond to medical treatment or who experience complications from BPH. This review aims to determine when LUTS or BPH should be surgically treated. A thorough search of the PubMed/Medline database was conducted from January 1990 to January 2022 using the following MeSH terms: “lower urinary tract symptoms”, “prostatic hyperplasia”, “prostatic hyperplasia/therapy”, “prostatic hyperplasia/complications”, “treatment outcome”, and “time to treatment”. Relevant studies were reviewed, and arguments both for and against early surgery for BPH were examined. The argument in favor of early surgery emphasized the advantages of surgery over medication for BPH in terms of both effectiveness and cost, as well as the potential for worse postoperative results if surgery is postponed. The argument against early surgery held that medicinal treatment is effective for carefully chosen people and can prevent the complications associated with surgical treatment of BPH, such as significant sexual adverse effects. Clinical trials may be used to assess the long-term benefits of sustained medical care vs. early surgical therapy, particularly in the elderly population. Until more definitive evidence is available, all treatment approaches have their advantages, and patients should be guided in making informed decisions.