To retrospectively investigate the characteristics of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia for which surgery was needed during the past 20 years. In particular, the chronologic change in prostate volume at surgery and the status of α₁-blocker use before surgery and its duration were studied.

The data from 371 consecutive patients with lower urinary tract symptoms/benign prostatic hyperplasia who had undergone surgery in our institute from 1987 through 2006 were retrospectively analyzed. The number of surgeries, type of surgical procedure, content and duration of medical treatment of lower urinary tract symptoms/benign prostatic hyperplasia before surgery, prostate volume on transrectal ultrasonography at baseline and at surgery, and the weight of the removed tissue were determined from the medical charts.

The number of surgeries suddenly began to decrease between 1987 and 1990 and again from 1991 to 1994, probably owing to the introduction of 2 nonselective α₁-blockers at those times in Japan. The percentage of use of α₁-blockers before surgery and the duration of use increased in each period. More than 80% of recent patients had received α₁-blockers before surgery, with an average duration of 3 years. Recent patients had a large prostate volume at baseline and at surgery compared with previous patients. Corresponding to the large prostate, open subcapsular prostatectomy was indicated in 18% of the recent patients.

Patients with surgical treatment after long-term use of α₁-blockers had large prostates at baseline and at surgery. Although α₁-blockers delayed the need for surgery by a few years, patients with a large prostate volume might finally need to undergo surgery.