Patient's question:
A 75-year-old male with oliguria, red-colored urine, frequent nighttime awakenings, insomnia, and reduced daytime fluid intake. He experiences an urge to urinate but cannot produce urine. The symptoms have persisted for one month. The patient also has mild cognitive impairment associated with aging.Doctor's answer:
Surgery remains an important treatment for benign prostatic hyperplasia. The indications for surgery include: ① Presence of lower urinary tract obstruction symptoms, with significant changes in urodynamic tests, or residual urine volume exceeding 60 mL; ② Severe symptoms of unstable bladder; ③ Presence of upper urinary tract obstruction and renal function impairment; ④ Multiple episodes of acute urinary retention, urinary tract infection, or gross hematuria; ⑤ Complication with bladder stones. For patients with long-term urinary tract obstruction, significant renal damage, severe urinary tract infection, or acute urinary retention, a catheter should be inserted first to relieve the obstruction. Surgery should be performed only after the infection is controlled and renal function recovers. If catheter insertion is difficult or prolonged, leading to urethritis, suprapubic bladder puncture and cystostomy may be an alternative. The indications for emergency transurethral resection of the prostate (TURP) must be strictly adhered to.