What criteria should I use to decide whether to refer a patient with BPH for surgical intervention?

To determine whether to refer a patient with benign prostatic hyperplasia (BPH) for surgical intervention, you should consider the following criteria, primarily focusing on the severity of their lower urinary tract symptoms (LUTS) and the effectiveness of prior treatments:

• Failure of Conservative and Drug Management: Refer men for specialist urological assessment and management if their LUTS fail to respond to drug treatment ¹,². Surgery is typically considered only if voiding symptoms are severe, or if conservative management and drug treatment options have been unsuccessful or are not appropriate ².
• Presence of Complications: Refer men for specialist assessment if their LUTS are complicated by recurrent or persistent urinary tract infection, urinary retention, renal impairment suspected to be caused by lower urinary tract dysfunction, or suspected urological cancer ².
• Chronic Urinary Retention: For men with chronic urinary retention, consider referral for surgery on the bladder outlet if they also have other bothersome LUTS but no impairment of renal function or upper renal tract abnormality ². Intermittent or indwelling catheterisation may be considered before offering surgery in men with chronic urinary retention ².