[Management of the bladder outlet obstruction associated with BPH in patients with special circumstances and/or complications].

INTRODUCTION

Medical or surgical treatment of lower urinary tract symptoms associated with the bladder obstruction due to BPH must take into account patient's comorbidities and tBPH complication. The objective is to review the different situations in order to optimize the treatment.

METHODS

A review of the literature was conducted in English on the Pubmed website using the following keywords: BPH; diabetes; anticoagulants; antiplatelet agents; renal insufficiency; indwelling catheter; bladder calculus; urinary tract infection; hematuria; chronic bladder retention or diverticulum. The bibliographical sources cited in the European recommendations have been used.

RESULTS

Some co-morbidities and complications may affect surgical outcomes: age is associated with increased anesthetic and surgical risks, diabetes with detrusor hypoactivity or overactivity that will not always be improved by surgery, chronic bladder retention with detrusor underactivity risk and anticoagulants and antiaggregants with an additional bleeding risk. Bladder stone should be treated with, in the majority of cases, BPH surgery. Bladder diverticulum is an indication of BPH surgery but not systematically associated with diverticulectomy. Persistent hematuria despite treatment with 5 alpha reductase inhibitor and repeated urinary tract infection are indications for surgery.

CONCLUSION

The presence of co-morbidities or complication related to BPH leads to specifics of care that should not be ignored urologists.

LEVEL OF EVIDENCE: 5 consensus d'experts.