By Joshua P. Langston, MD
Benign Prostatic Hyperplasia (BPH) is one of the most common reasons that men visit a urologist, yet many patients historically have balked at traditional surgery for fear of developing urinary or sexual complications.
Thankfully, creative new procedures have emerged alongside novel medications in recent years to treat men with less invasive methods, some of them non-surgical, for a faster recovery with fewer potential side effects.
BPH, or Enlarged Prostate, affects about half of all American men between the ages of 51 and 60, a figure that jumps to 70 percent in men ages 60 to 69 and 80 percent of those over 70. The risk is even higher in men who are overweight or have a family history of the condition.
For years, transurethral resection of the prostate (TURP) has been the most frequent treatment for uncomfortable symptoms such as frequent urination, a weak or interrupted urine stream, and an inability to fully empty the bladder.
While TURP effectively removes excess prostate tissue blocking urine flow, the procedure was historically associated with a hospital stay and unwanted side effects. Post-surgical risks included bleeding, urinary tract infection, changes in sexual function and incontinence.
Surgeons have long recognized the need for more procedural options, especially given that prostate size can vary significantly by patient – from the approximate size of a walnut to that of a softball, in fact!
One newer option is Holmium laser enucleation of the prostate (HoLEP), which is particularly effective in men with larger prostates. Performed endoscopically via the urethra, HoLEP breaks down excess tissue into easily removable fragments, with a much better patient experience and long-term outcomes compared to TURP.
Another promising procedure is Aquablation, which uses a high-pressure waterjet guided by ultrasound and robotic technology to precisely target surplus prostate tissue and preserve surrounding areas.
Even less invasive is Prostate Artery Embolization (PAE), performed by interventional radiologists. Through a slender catheter inserted into arteries that feed the prostate, they inject a solution designed to block blood supply to the gland. The prostate then typically shrinks by 20 to 40 percent over a six-month period, yielding the desired improvement in urinary function.
More innovation is on the horizon, including methods that involve no dissection or cauterization of prostatic tissue whatsoever.
Temporary or permanent prostatic stents, for example, can reopen the urethra and improve urine flow. Some of these devices have entered the market, while others still are in clinical trials. Another quick outpatient procedure, UroLift™, involves working through the urethra to place tiny implants that lift or hold enlarged prostate tissue that is impeding urine flow.
The overall message is that men do not have to suffer from the discomfort, anxiety, embarrassment and sleepless nights that BPH can cause. Urologists have a much fuller array of tools to improve urinary function without overly impacting quality of life, including for men ineligible for, or uninterested in, traditional surgery.
We encourage men with troublesome symptoms to visit a specialist without delay to discuss all of their treatment options.
Dr. Langston is a urologist with subspecialty fellowship training in Men’s Health. He is also Managing Partner and Chief Executive Officer at Urology of Virginia. urologyofva.net
