When and how should Benign Prostatic Hyperplasia be treated?

Benign Prostatic Hyperplasia or BPH is the growth of the prostate gland that causes difficulty urinating. It produces bothersome symptoms for the patient, such as the need to urinate very frequently, with a weak stream or having to run to keep from leaking urine. In addition, if not controlled in time, BPH can cause urinary tract infections or affect the kidneys, among other problems.

There is currently a great deal of confusion regarding the treatment of BPH. The first thing to clarify is that it is not necessary to treat a prostate that does not produce symptoms of obstruction or is not at risk of complications, regardless of its size.

When indicated, treatment can be with pills or with surgery. There are different types of surgical techniques. Currently, two of the most commonly used techniques are intraprostatic vaporization or Rezum and endoscopic prostatic laser enucleation.

Intraprostatic vaporization or Rezum

This procedure consists of an injection of water vapor into the prostate that achieves a reduction in its size. It is performed endoscopically through the urethra and on an outpatient basis, since it does not require general anesthesia, and there is little bleeding. Another important advantage is that, unlike most treatments for BPH, it does not affect ejaculation, that is, the release of semen during orgasm.

Endoscopic laser endoscopic prostatic enucleation.

It consists in the removal through the urethra of the internal part of the prostate which is the one that produces the obstruction. It manages to greatly enlarge the urine duct, with which the symptoms usually improve significantly and for many years or forever. In most cases it is not performed on an outpatient basis and usually alters ejaculation. This type of surgery is technically complex and must be performed by a specialized surgeon.

Because of these and other differences between treatments, it is important that your urologist has mastered all the techniques available to treat BPH so that he can adapt them to the needs and preferences of each patient.

Dr. Ivan Schwartzmann is a specialist in Urology and an expert in BPH and reconstructive urology. He is currently a clinical associate professor at the Autonomous University of Barcelona and works at the Fundació Puigvert (C. de Cartagena, 340, 350, 08025 Barcelona).