Acute urinary retention is an important clinical indicator that reflects how far benign prostatic hyperplasia (BPH) has progressed. In particular, when the prostate protrudes into the bladder, medication alone is often insufficient to prevent further deterioration. According to a study published by Keqin and colleagues in *The Journal of Urology* (2007), patients with intravesical prostatic protrusion (IPP) of 10 mm or more showed significantly lower responsiveness to medication, while the risk of acute urinary retention increased markedly. In other words, patients with such anatomical changes may experience sudden worsening of urinary function even from minor triggers such as cold medication or temporary physical fatigue. Therefore, establishing an appropriate treatment strategy before bladder function becomes further impaired is critically important.
The key to diagnosing BPH is not simply measuring prostate size but evaluating changes in prostate shape. In particular, when the prostate’s median lobe protrudes into the bladder, medication tends to be less effective and the risk of urinary retention increases significantly.
In recent years, treatment strategies for BPH have shifted away from simply removing prostate tissue toward approaches that carefully evaluate prostate anatomy, median lobe protrusion, and bladder function in order to minimize recurrence. Holmium laser enucleation of the prostate (HoLEP), for example, uses a holmium laser to remove the prostate tissue that obstructs the bladder outlet at its root, resulting in a more fundamental improvement in urinary flow. The holmium laser technique has also shown stable outcomes in patients with large prostates or those with significant median lobe protrusion.
Notably, holmium laser surgery is internationally recognized as one of the standard procedures with the lowest recurrence rates. Evidence from international studies supports this. A study published by Krambeck and colleagues in *The Journal of Urology* (2013) reported a reoperation rate of less than 1 percent at 10 years following HoLEP. Another study published by Elzayat and colleagues in *European Urology* (2005) found that 98 percent of patients with acute urinary retention regained normal urination after undergoing HoLEP.
Dr. Ryu Kyung-ho of Goldman Urology Clinic Gangnam Branch explained that during seasonal transitions, factors such as temperature fluctuations, autonomic nervous system responses, and the use of cold medications can cause BPH symptoms to worsen suddenly. He emphasized that acute urinary retention, in which urine cannot be passed at all, is a medical emergency that can threaten both bladder and kidney function and should never be ignored. He further noted that in the treatment of BPH, the critical factor is not simply prostate size but how the prostate has deformed within the bladder. When median lobe protrusion is present, relying solely on medication may be insufficient, and considering surgical options such as HoLEP—which fundamentally improves the bladder outlet—at the appropriate time can help preserve long-term urinary function.