Quick Case Study

Newer Treatments for Benign Prostatic Hyperplasia Improve on ‘Gold Standard’

Burgeoning options for patients may lead to increased durability, faster recovery times

BPH Graphic

A man in his early 60s presented to urologist Samuel Eaton, MD, with the uncomfortable urinary symptoms associated with benign prostatic hyperplasia (BPH). The patient had already undergone two transurethral resection of the prostate (TURP) procedures in the span of 20 years, but the second procedure only lasted about five years, which put into question the durability of a third.

“BPH treatments are generally effective initially, but as the prostate continues to grow as people get older, there is the possibility of needing additional treatments down the line,” says Eaton. “TURP has been and probably still is the gold-standard treatment for BPH, but a lot of times, newer procedures can match or beat that effectiveness with fewer side effects and fewer problems.”

Question: What procedure did Eaton perform to optimize recovery time for this patient?

Answer: In an era of burgeoning options, Eaton chose to treat this patient with a transurethral Thulium laser enucleation of the prostate (ThuLEP), which removes excess prostate tissue blocking urine flow using a laser as opposed to the bipolar electrocautery used in TURP. “With this patient’s goals of wanting a more durable solution than his previous TURP procedures and a relatively fast recovery time, the laser procedure made the most sense,” Eaton says.

The ThuLEP procedure simulates the process used in the classic open procedure but does not require any incisions; instead, a surgeon enters through the urethra to more efficiently remove parts of the prostate in a few large pieces. The advantage of this approach, Eaton says, is a decreased bleeding risk and potentially increased durability over the standard TURP due to the technique used, often with 10 or more years before a patient would need to think about repeating a procedure. “The patient’s recovery was also much quicker than it had been with TURP, with a quicker return to a normal voiding and less bleeding in the immediate period after surgery,” he adds. This often means an overnight hospital stay can be avoided.

While there are a growing number of options for the management of BPH, Eaton explains that all of the procedures have a similar goal: to open up the urethra and the affected area of the prostate to enable men to empty their bladders more completely. “But each method achieves it differently and may work better or worse in certain circumstances, and each one comes with its own set of potential side effects risks, including urinary and sexual function risks.”

Duke offers a wide range of effective potential procedures, and Eaton highlights some other relatively new options that patients may consider:

  • Rezūm (NxThera, Inc., Maple Grove, MN), a quick outpatient procedure in which water vapor is injected into the prostate to treat the extra prostate tissue that is causing symptoms, which can be done in the office with local anesthesia. “It can be very effective, though it sometimes takes longer to realize those effects,” Eaton adds.
  • Robotic-assisted simple prostatectomy, a minimally invasive alternative to open simple prostatectomy. The advantage is substantially decreased blood loss and time in hospital, and improved recovery time compared to open procedures, Eaton explains. This approach is generally reserved for treating very large prostates.
  • UroLift System (Neotract, Pleasanton, CA), a procedure that uses tacking sutures to open up the area of the prostate. The procedure takes just a few minutes and carries the lowest risk of retrograde ejaculation out of all these procedures, Eaton says. “The potential downside of that procedure, though, is that since you're not removing any tissue, its durability compared to some of the other more standard treatments may not be as good, but there is little longer-term data,” he adds.

“The advantage of having so many options is that it allows the physician to work with the patient to tailor treatment to their goals, their needs, and their concerns and come to the best solution,” Eaton says.