New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review

INTRODUCTION: Life expectancy is constantly increasing and as a consequence older men, frequently with multiple comorbidities, are seeking treatment for benign prostatic hyperplasia. Given their frail health, these men need extreme attention in their management, as efficacious and safe treatment strategies in the general population may not be adequate for them. EVIDENCE ACQUISITION: The National Library of Medicine Database was searched for relevant articles published between 2006 and 2015. Each article's title, abstract and text were reviewed for their appropriateness and their relevance. 57 articles were eligible for the review. EVIDENCE SYNTHESIS: In the elderly and frail, a I-antagonists should be used with caution given the risk of orthosralic hypotension and consequent falls, cause of significant morbidity in the elderly. 5ARIs present a good safety profile. Anticholinergics must also be prescribed with caution, given the risk of aggravating symptoms of dementia due to a central blockage of cholinergic neuronal pathways. Prostatic urethral lift is a medical device with low morbidity and valid functional results, which appear to endure over time. Prostatic artery embolization is demonstrating good results with minimal complication rates. Laser prostate vaporization or enucleation is also safe in elderly men and in those,receiving anticoagulation therapy, due to its excellent hemostatic effect on prostatic tissue. CONCLUSIONS: Urologists should be familiar with the safety and efficacy profile of medical and surgical therapy in the elderly population, given the inevitable increase in older patients which we will observe in the near future.