Benign prostatic hyperplasia (BPH) is highly prevalent among ageing men and frequently results in lower urinary tract symptoms (LUTS) that significantly impair quality of life. With increasing life expectancy, clinicians are increasingly required to manage elderly patients with complex comorbidities, frailty, and reduced physiological reserve. While pharmacological therapy remains the first-line treatment, surgical intervention is often required for refractory or complicated disease. Decision-making in this population extends beyond traditional surgical considerations and requires a holistic, patient-centered approach. This narrative review has two primary aims. First, it examines contemporary surgical treatment options for BPH in elderly patients, integrating current evidence on efficacy and safety. Second, and more critically, it advocates minimally invasive surgery as a viable and underutilized alternative to long-term urinary catheterization in patients with multiple comorbidities who may not be suitable candidates for conventional surgery. In addition, it supports the early involvement of transdisciplinary geriatric medicine teams in the development of management plans and the selection of surgical strategies. Incorporating comprehensive geriatric assessment (CGA) into routine practice may improve risk stratification and better align treatment with patient-centered outcomes, such as functional independence and quality of life.
Cureus. 2026 Jun 22*** epublish ***
Yousef E Abu Osba, Sara B Alrafayia
Urology, University Hospitals of Leicester NHS Trust, Nottingham, GBR., Obstetrics and Gynecology, Nottingham University Hospitals NHS Trust, Nottingham, GBR.