Conservative approach for a giant prostatic hyperplasia of 1280 ml: a case report and literature review

Benign Prostatic Hypertrophy (BPH) affects at least one-third of men over 60 years. A giant prostatic hyperplasia (GPH) is a prostate enlargement that exceeds 500 g. We present a case of a 72-year-old man with a GPH volume of 1280 ml, referred to our hospital for a worsening of the lower urinary tract symptoms (LUTS), bilateral loin pain and kidney failure. Although the patient had a negligible post-void residual urine, he had bilateral hydronephrosis. The patient was managed conservatory because of a high anesthesiologic risk but a bilateral percutaneous nephrostomy was placed soon due to kidney function worsening. The presence of serious comorbidities and the resolution of the loin pain and the renal failure, achieved first with the nephrostomy and then with periodic replacement of ureteral stents, along with an improvement of the LUTS obtained with medical therapy, have oriented us towards a conservative management of the patient.