Benign Prostatic Hyperplasia in Routine Urological Practice: A Twenty Four Month Cohort of Three Hundred and Twelve Men

Dr. Nrapendra Sharma, Mohd. Khursheed, Shadaab Malik

Benign Prostatic Hyperplasia; Lower Urinary Tract Symptoms; IPSS; Α-Blocker; 5-Alpha Reductase Inhibitor; TURP; Holep; LUTS.

Benign prostatic hyperplasia (BPH) and the associated lower urinary tract symptoms (LUTS) represent one of the most common causes of urological consultation in older men, with progressive prevalence rising from approximately 25% at age 50 to over 80% by age 80. Treatment options span watchful waiting with lifestyle intervention, pharmacotherapy (α-blockers, 5-alpha reductase inhibitors, combinations, anticholinergics for storage-predominant symptoms), minimally invasive surgical therapies (TURP, HoLEP, laser), and open or robotic prostatectomy for very large prostates. We prospectively followed 312 men with moderate-to-severe LUTS attributable to BPH at a tertiary urology service over 24 months. Mean IPSS at baseline was 18.6, falling to 11.2 (α-blocker monotherapy), 7.2 (combination 5-ARI + α-blocker), 12.6 (5-ARI monotherapy), and 5.4 (surgical intervention) at 24 months. Combination therapy and surgical intervention showed superior symptom relief and reduced disease progression. Strongest independent predictors of treatment success included combination therapy, larger prostate volume, severe baseline symptoms, adherence to medication, and patient education engagement. The findings support structured assessment-based treatment selection with attention to disease characteristics that predict response.

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