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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Online ISSN 1827-1758
Simone ALBISINNI 1, Fouad AOUN 1, Thierry ROUMEGUÈRE 1, Francesco PORPIGLIA 2, Andrea TUBARO 3, Cosimo DE NUNZIO 3
1 Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; 2 Department of Urology, Ospedale San Luigi Gonzaga, University of Turin, Orbassano, Italy; 3 Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy
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. Across medications, α1-antagonists should be used with caution given the risk of orthostatic 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. Fesoterodine is the only anticholinergic which has been classified as beneficial across this class of medications. Minimally invasive surgical approaches for frail old men are also available today. 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 haemostatic effect on prostatic tissue. 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.