When benign prostatic hyperplasia meets inguinal hernia: Development of a multidisciplinary management framework for elderly men

Lower urinary tract symptoms (LUTS) / Benign Prostatic Hyperplasia (BPH) and inguinal hernia (IH) are prevalent conditions among elderly men and frequently coexist in clinical practice. However, their concurrent management remains fragmented because they are traditionally addressed within separate surgical and urological specialties. This review aims to synthesize evidence relevant to men with coexisting LUTS/BPH and IH, also, to propose a multidisciplinary clinical pathway for the assessment and management of elderly patients presenting with these comorbidities.

PubMed, Embase (Ovid), and Web of Science Core Collection were searched from inception to August 2026. Among 752 unique database records, 172 underwent detailed assessment and 44 reports were included. Reports were mapped by clinical question and study design, including question-specific Oxford Centre for Evidence-Based Medicine levels.

The 44 reports addressed coexistence, postoperative urinary retention (POUR) risk, POUR prevention, and combined or staged operations. In RETAINER I (n = 4,151), POUR occurred in 5.8% of men and 9.5% of men aged 65 years or older. Previous retention predicted risk, whereas diagnosed benign prostatic enlargement and International Prostate Symptom Score were not independent predictors. A randomized trial found no benefit from routine intraoperative catheterization, and overlapping alpha-blocker meta-analyses were discordant. Evidence for a causal benign prostatic hyperplasia-hernia relationship was inconsistent and confounded. Combined surgery was feasible in selected series, but comparative evidence was sparse and did not establish a preferred sequence.

The framework is a decision aid, not a validated protocol. Disease-specific indications should determine priority. Combined surgery may be considered only when both procedures are independently indicated and local expertise permits.