Surgical management of benign prostatic hyperplasia in elderly and frail patients: a narrative review

The aim of this review was to evaluate the outcomes of the various surgical techniques available today, focusing on their applicability to frail and/or elderly patients.

Transurethral resection of prostate (TURP) allowed a reduction of hemorrhagic complications compared to open simple prostatectomy. However, laser surgery show the best safety profile among the standards techniques. Importantly, most of studies demonstrate no difference in efficacy of LUTS management in frail or elderly population compared to younger patients. Recently, mini invasive surgical therapies (MIST) emerged, allowing a reduction in complication and a potential feasibility under general anesthesia. Prostatic artery embolization (PAE) showed longer procedures but equivalent efficacy compared to younger population. Data remains scarce regarding prostatic uretral lift (PUL) and water vapor thermal therapy (WVT), but studies suggest promising results, particularly for trial without catheter at 12 months for elderly population.

In frail and elderly patients, laser surgery significantly reduces the hemorrhagic complications compared to traditional techniques. In addition, laser surgery shows equivalent efficacy in elderly and young population, reinforcing the indication of laser in elderly when feasible. The option of MISTs is rising, but validation is needed with further studies.