Men with benign prostatic hyperplasia (BPH) have a growing number of treatment options. Although previous options often excluded men with larger prostates or those taking anticoagulants, newer management strategies allow a greater range of men to be treated and result in fewer adverse effects.

“At Duke, we see the full gamut, from men who are just noticing symptoms to those who can’t void at all and require a catheter,” says Samuel Eaton, MD, assistant professor of surgery in urology. “Being able to offer the whole breadth of techniques really allows us to cater our treatment strategies to each patient.”

Eaton explains that, although medication is still the initial treatment strategy, if it loses its efficacy, then surgical intervention may be necessary. Historically, standard surgical treatments for BPH have comprised removing excess prostate tissue either via open surgery or transurethral resection using electrical current. These treatments, while effective, can occasionally result in significant blood loss and prolonged catheter time.

Newer techniques can help avoid these issues, Eaton says, while providing treatment options to a larger number of men. The least invasive of the newer techniques is UroLift (Neotract, Pleasanton, CA), a prostate implant that lifts prostate tissue away from the urethra, thereby improving urine flow. Also on the BPH team with Eaton is Brian Whitley, MD, a urologist who specializes in the procedure. He explains that, in addition to being minimally invasive, advantages include the short time of operation and recovery, with only 1 day of catheter use, and fewer sexual adverse effects.

For men with more severe symptoms or a larger prostate, UroLift may not be an option; they require a process that removes the extra prostate tissue. One less widely available option is thulium laser enucleation of the prostate (ThuLEP).

Available at Duke, ThuLEP allows for the efficient, endoscopic removal of prostatic tissue from larger prostates while also minimizing blood loss and hospital stay. Most patients are able to go home the same day as the surgery. The penetration of the laser energy is also lower than that of the electrical energy employed in earlier techniques, likely resulting in less damage to structures around the prostate.

“Over the past few years, there have been a lot of advances in different minimally invasive techniques to allow us to treat enlargement of the prostate with lower morbidity and be able to do more treatments endoscopically without any incisions, even in very large prostates,” Eaton says.

In the rare cases where the prostate is too large to treat endoscopically, Duke offers a minimally invasive refinement of robotic-assisted simple prostatectomy.

“At Duke Urology, we are able to offer a full range of treatment options for a common male problem,” Eaton says. “This reflects the division’s broader men’s health initiative at Duke Raleigh Hospital to offer comprehensive men’s health care across the breadth of their needs.”