Dr. Na Jun-chae, Goldman Urology Jamsil Branch
Benign prostatic hyperplasia (BPH) is a condition where the prostate gland becomes enlarged, pressing on the urethra, which obstructs the smooth flow of urine and causes various voiding dysfunctions. Most patients initially attempt watchful waiting or medication, but if these methods do not resolve the issue, surgical treatment is considered. For BPH surgery, various methods can be chosen depending on the patient's condition and needs. A crucial point is that a precise diagnosis is essential to definitively ascertain whether surgery is truly necessary and which specific surgical procedure is required.
There are several surgical methods for benign prostatic hyperplasia. First, HoLEP (Holmium Laser Enucleation of the Prostate) surgery uses a holmium laser to remove the enlarged prostate tissue by completely separating it from the prostatic capsule and expelling it from the body. Prostatic urethral lift (UroLift) is a relatively simple procedure that involves using an endoscope to tie the prostate tissue to the left and right, thereby expanding the urethra and improving urine flow.
Waterjet robotic surgery (AquaBlation) uses high-pressure water jets to remove enlarged prostate tissue without generating thermal energy. The Rezūm system is a procedure that injects steam into the prostate with small needles to cause tissue necrosis. For elderly patients or those for whom preserving ejaculatory function is important, iTIND (temporary implantable nitinol device) surgery can be considered. iTIND involves inserting a nitinol stent into the prostate for one week to widen the urethra. Each of these methods has its own advantages and disadvantages, and the choice of surgery may vary depending on the patient's condition and specific needs.
When the prostate gland's size is 70-80g or more, it is typically referred to as a giant prostate. In such cases, HoLEP surgery is generally recommended. HoLEP surgery can effectively remove prostate tissue even in cases of a giant prostate. Furthermore, HoLEP surgery can yield significant benefits when the median lobe is developed, in cases of bladder neck stenosis (the transitional area from the bladder to the urethra), or when the prostate protrudes into the urethra or bladder.
For elderly patients or those with underlying medical conditions, especially patients who must take aspirin due to cerebral infarction, less invasive surgical methods are recommended. Procedures such as waterjet robotic surgery, prostatic urethral lift, or Rezūm treatment carry a lower risk of bleeding and can be performed relatively simply.
Some patients feel burdened by prolonged catheterization. For patients who experience significant discomfort with catheter use, less invasive surgeries like prostatic urethral lift (UroLift) are recommended. This method allows for discharge without a catheter, thereby minimizing patient inconvenience. Furthermore, HoLEP surgery and waterjet robotic surgery (AquaBlation) also typically do not require prolonged catheterization.
For patients concerned about recurrence, HoLEP surgery or waterjet robotic surgery (AquaBlation) is recommended. These two methods effectively remove prostate tissue, resulting in a lower recurrence rate. Conversely, prostatic urethral lift (UroLift) merely ties the prostate tissue to the left and right, leading to a relatively higher recurrence rate. For relatively younger patients, preserving ejaculatory function can be an important factor. Since HoLEP surgery carries the possibility of retrograde ejaculation, prostatic urethral lift, the Rezūm system, waterjet robotic surgery, or iTIND procedures are recommended.
The patient's financial situation is also a crucial factor in choosing a surgical procedure. HoLEP surgery is covered by national health insurance, making the financial burden relatively lower. Other surgical methods may not be covered by insurance, potentially resulting in higher costs.
For benign prostatic hyperplasia surgery, it is crucial to select the most suitable surgical method tailored to each patient's individual condition and needs. Choosing a medical institution capable of performing all types of BPH surgeries, thus offering truly personalized treatment, is important. Furthermore, if you are considering BPH surgery, it is advisable to have a thorough consultation with your primary physician to determine the most appropriate surgical method for you.