Abstract：
BACKGROUND: Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to to discuss the optimal timing of surgical management of LUTS/BPH.
METHODS: A literature search was conducted on Pub-Med/MEDLINE database to identify reports published from January 1990 until January 2022 by combining the following MeSH terms: \"Lower Urinary Tract Symptoms\"; \"Prostatic Hyperplasia\"; \"Prostatic Hyperplasia/therapy\"; \"Prostatic Hyperplasia/complications\"; \"Treatment Outcome\"; \"Time-to-Treatment\". Evidence supporting or not early surgical treatment of BPH was examined and reported in a pros and cons form.
RESULTS: The \"pro early surgery\" highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The \"con early surgery\" considered that medical therapy is efficient in well-selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects.
CONCLUSIONS: Clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involved in the treatment decision.
METHODS: A literature search was conducted on Pub-Med/MEDLINE database to identify reports published from January 1990 until January 2022 by combining the following MeSH terms: \"Lower Urinary Tract Symptoms\"; \"Prostatic Hyperplasia\"; \"Prostatic Hyperplasia/therapy\"; \"Prostatic Hyperplasia/complications\"; \"Treatment Outcome\"; \"Time-to-Treatment\". Evidence supporting or not early surgical treatment of BPH was examined and reported in a pros and cons form.
RESULTS: The \"pro early surgery\" highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The \"con early surgery\" considered that medical therapy is efficient in well-selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects.
CONCLUSIONS: Clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involved in the treatment decision.
摘要：
背景：在过去的几十年中，与良性前列腺增生（BPH）相关的下尿路症状（LUTS）的治疗发生了变化，药物治疗成为主要的治疗方式，而手术主要保留给对药物治疗无反应或出现BPH并发症的患者。这里,我们的目的是讨论LUTS/BPH手术治疗的最佳时机。
方法：在Pub-Med/MEDLINE数据库上进行了文献检索，以通过结合以下MeSH术语来确定1990年1月至2022年1月发布的报告：“下尿路症状”；“前列腺增生”；“前列腺增生/治疗”；“前列腺增生/并发症”；“治疗结果”。对支持或不支持BPH早期手术治疗的证据进行了检查和报告。
结果：“早期手术”强调了手术治疗BPH优于药物治疗的疗效和成本效益，以及延迟手术治疗术后预后较差的可能性。“早期手术”认为药物治疗对精心选择的患者有效，可以避免BPH手术治疗固有的严重风险，包括重要的性副作用。
结论：比较长期药物治疗与早期手术治疗结果的临床试验可以确定哪种方法在人口老龄化的背景下更长期有益。在那之前,这两种方法都有其优势,患者应参与治疗决策.
方法：在Pub-Med/MEDLINE数据库上进行了文献检索，以通过结合以下MeSH术语来确定1990年1月至2022年1月发布的报告：“下尿路症状”；“前列腺增生”；“前列腺增生/治疗”；“前列腺增生/并发症”；“治疗结果”。对支持或不支持BPH早期手术治疗的证据进行了检查和报告。
结果：“早期手术”强调了手术治疗BPH优于药物治疗的疗效和成本效益，以及延迟手术治疗术后预后较差的可能性。“早期手术”认为药物治疗对精心选择的患者有效，可以避免BPH手术治疗固有的严重风险，包括重要的性副作用。
结论：比较长期药物治疗与早期手术治疗结果的临床试验可以确定哪种方法在人口老龄化的背景下更长期有益。在那之前,这两种方法都有其优势,患者应参与治疗决策.
