In middle age, most men begin to battle lower urinary tract symptoms or LUTS, most of which are precipitated by a very usual and benign issue known as benign prostatic hyperplasia or BPH. This is what we call the proliferation of cells within the prostate that cause it to enlarge and, ultimately, restrict the outflow of urine. This happens because as the prostate grows, it clamps down on the urethra and narrows its diameter. It is estimated that about 50% of men over the age of 50 and 80% of men over the age of 80 experience BPH. Hence, the likelihood of frequent or incomplete urination, dribbling, or waking up to pee at night is a genuine possibility starting when we hit our 40s.
The almost ubiquitous nature of BPH has led to phenomenal innovation in its treatment. Just a couple of decades ago, urologists were limited to a few BPH treatment options, including transurethral resection of the prostate (TURP) and a simple prostatectomy. Today, we have thermal ablation technologies that take as little as five minutes in the office, laser therapies, robotically driven water jet therapies like Aquablation, and many more.
We always take a stepwise approach when caring for urologic concerns like BPH. We start patients on the least invasive yet still effective option and move on to the next when we find the therapy is not working. Medication like Flomax may be a first line of defense for many. However, medications have side effects and waning effectiveness over time. Therefore, we often consider an innovative steam-based ablation procedure, Rezum, as the first step. This option offers most qualifying patients excellent results for five-plus years. Taking only five minutes in the office, it is an incredibly convenient option for most.
What Happens When You Need Retreatment?
Fortunately, there’s no contraindication for treating the prostate a second time when prostatic tissue growth becomes problematic again, and that is one of the great benefits of the most common BPH therapies we have today. Whether it’s a Rezum, Urolift, or any other minimally invasive treatment, there’s almost always the possibility of a second procedure unless the patient’s health status has changed such that it is not possible.
Other procedures such as Holmium laser, or HoLEP, Aquablation, simple proctectomy, and green light laser remove most of the pulp of the prostate, leaving only the outer shell intact. These procedures do not typically need follow-up surgery for quite some time, if ever.
Which Option Do I Choose?
As mentioned above, the most popular (amongst urologists) and widely used BPH therapies today have excellent safety profiles and compelling track records. That said, some are more suited to certain patients than others. For example, certain procedures may be more suited to a patient with a larger prostate versus a minimally invasive option.
Most importantly, if you are experiencing urinary issues, don’t let fearing the worst stop you from getting care from a qualified urologist. Remember, prostate cancer typically does not manifest with lower urinary tract issues in its early stages. Instead, patients are very likely to have BPH or another benign condition
But rather than modify their lifestyles to accommodate the urinary problems, most patients find that the best option, and the one they wish they had tried sooner, is a minimally invasive intervention. For the next steps, we look forward to speaking with you about the various options associated with BPH treatment. We want you to understand that many effective BPH treatment options are available, and getting relief starts with coming into the office for a consultation.
We look forward to seeing you soon.