A 65-year-old man with benign prostatic hyperplasia has a postvoid residual of 350 mL, bilateral hydronephrosis, and a creatinine of 2.8 mg/dL. He reports two episodes of urinary retention treated with catheterisation. Which is the most appropriate definitive management?

• A Alpha-blocker (tamsulosin) and 5-alpha reductase inhibitor combination
• B Clean intermittent self-catheterisation (CISC)
• C Prostate artery embolisation (PAE)
• D Transurethral resection of the prostate (TURP) ✓

Explanation

Absolute indications for surgical intervention in BPH include: recurrent urinary retention, bladder stones, recurrent UTIs, haematuria refractory to medical treatment, and upper tract dilatation with renal impairment (as here — creatinine 2.8 with bilateral hydronephrosis). TURP is the gold standard surgical treatment for symptomatic BPH with absolute indications. Medical therapy is inappropriate when renal impairment from outflow obstruction is present. PAE is for selected cases without absolute indications.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.