BPH: predictors of disease progression and transition from conservative to surgical treatment.

Introduction. Some patients with benign prostatic hyperplasia (BPH) do not respond to treatment or the disease progresses during conservative treatment. It seems relevant to identify significant predictors of BPH progression and transition from conservative to surgical treatment. Materials and methods. The review was conducted using the databases PubMed, Embase, Cochrane Library, Scientific Electronic Library eLlibrary.ru and the Russian Science Citation Index. The database search was carried out using the following keywords in English and their analogues in Russian: «benign prostatic hyperplasia», «benign prostatic obstruction», «bladder outlet obstruction», «lower urinary tract symptoms», «medical therapy», «pharmacotherapy», «alpha-blockers», «5-alpha-reductase inhibitors», «predictors of treatment failure», «predictors of benign prostatic hyperplasia progression», «intravesical prostatic protrusion». There were no restrictions on years of publication. At the first stage, 695 sources were found, 58 articles were selected for inclusion in the review. Results. The most significant predictors of BPH progression and failure of conservative treatment are the following: age; obesity; prostate volume; prostate specific antigen (PSA) level; inflammation in the prostate; intravesical prostatic protrusion; IPSS score; volume of residual urine; maximum urination rate. To comprehensively consider the influence of several factors on the clinical course of BPH, various nomograms can be used. Conclusions. All noted signs can be successfully used as predictors of disease progression when planning and dynamic monitoring of conservative treatment. Based on them, it becomes possible to identify a group at risk of progression of BPH, in which early surgical intervention is advisable.