UroLift for BPH and other new horizons for treatment of benign prostatic enlargement

Mrs Maya Harris

By Maya Harris, consultant urologist BPC

Traditionally, only TURP with its significant side-effects was available for men who suffer from symptoms caused by benign prostatic hyperplasia (BPH).  GreenLight Laser prostatectomy, introduced by the Birmingham Prostate Clinic in 2007, was the first minimally-invasive option for BPH.  Recently, more procedures have appeared on horizon.

I am a urologist with a special interest in BPH and recently attended the American Urological Association in Boston, Massachusetts, where the new procedures were showcased.  In this article, I would like to discuss their reported advantages and outcomes and compare them with audits of my own work.

The Urolift procedure is a minimally-invasive treatment using the insertion of small implants which retract and open the passage to urine in order to relieve the bladder blockage.  Typically, no overnight hospital-stay or catheter insertion postoperatively is required and recovery is quick.

Rezūm System is another newcomer to the scene of BPH surgery, invented and developed by a Swedish surgeon.  It uses injection of sterile water vapor to destroy prostate tissue.  Over the time of approximately three months, the body healing response removes the dead cells and shrinks prostate, opening the passage to the flow.  Data up to two years showed durable improvement of the flow and symptoms with this quick and minimally-invasive procedure without side-effect of erectile dysfunction.  However, postoperatively it required a catheter for up to one week.  In my opinion, this procedure would be a good option for patients already catheterised or medically unfit for other procedures.

Aquablation is removal of the prostate by a high velocity saline jet.  The procedure duration and side-effects are independent of size of the prostate, as it is robotically-driven after planning by the operator.  It also aims not to use any heat, such as diathermy, and postoperative bleeding is stopped by insertion of a large catheter and bladder washout (irrigation).  The results presented showed non-inferiority compared to TURP with less dysuria and irritative symptoms as no heat was used.  Aquablation will be an attractive option for prostates larger than 100 grams in the future when the technique is fully-developed and adopted.

In conclusion, I was impressed by the developments in the new procedures for BPH.  As a urologist, I am excited about being able to treat BPH with procedures which result in quick recovery and do not affect sexual function, as well as tailored to the presenting complaint and patient’s preference.