Can Long-Term LUTS/BPH Pharmacological Treatment Alter the Outcomes of Surgical Intervention?

The document reviewed the effects of long-term pharmacological treatment for benign prostatic hyperplasia (BPH) on surgical intervention outcomes, revealing limited evidence to determine if medical therapy delays surgery or alters the characteristics of men who undergo surgery. It speculated that men receiving surgery might be older, have larger prostates, and more comorbidities, although advancements in surgery and postoperative care could mitigate these factors. The review emphasized the importance of identifying the ideal candidates for surgical versus medical therapy and noted the role of urinary retention and detrusor decompensation in predicting the failure of pharmacological treatment. Lifestyle modifications were mentioned as influential on BPH progression and symptoms. The document also discussed the long-term effects of finasteride, indicating it reduces BPH-related events but may raise depression risk, and addressed the sexual side effects of 5-alpha reductase inhibitors, suggesting these may be underreported despite their efficacy in symptom treatment.