Acute urinary retention is an important clinical indicator of how far Benign Prostatic Hyperplasia (BPH) has progressed. Especially if the prostate is protruding toward the inside of the bladder, it is often difficult to prevent worsening with medication alone. According to a paper published by Keqin's research team in The Journal of Urology (2007), when intravesical prostatic protrusion (IPP) is 10mm or more, the responsiveness to medication is distinctly low, while the risk of acute urinary retention significantly increases. In other words, for patients with anatomical changes, even minor stimuli such as taking cold medicine or decreased physical strength can abruptly worsen voiding function. Therefore, it is more important than anything else to establish an appropriate treatment strategy before bladder function is further damaged.
The core of BPH diagnosis is not the size of the prostate but the identifying whether there are morphological changes. In particular, caution is required for median lobe hypertrophy, where the prostate protrudes toward the inside of the bladder, as it can cause decreased drug response and a skyrocketing risk of urinary retention.
BPH treatment in recent years has shifted focus from simple removal to accurately evaluating the shape of the prostate, median lobe protrusion, and bladder function to minimize recurrence. Especially in the case of HoLEP (Holmium Laser Enucleation of the Prostate) surgery, it provides a fundamental improvement effect because it utilizes a holmium laser to completely remove the enlarged prostate tissue that is blocking the bladder outlet. Holmium lasers show stable voiding improvement effects even for patients with large prostates or median lobe protrusion.
Above all, the holmium laser is known internationally as one of the standard surgeries with the lowest recurrence rate. This can be confirmed in overseas studies as well. According to a paper published by Krambeck's research team in The Journal of Urology (2013), the 10-year reoperation rate for holmium laser is reported to be less than 1%. A paper published by Elzayat's research team in European Urology (2005) also showed that 98% of patients with acute urinary retention recovered normal voiding after HoLEP surgery.
Director Ryu Kyeong-ho of Goldman Urology Clinic Gangnam Branch said, "In the change of seasons, BPH symptoms often worsen rapidly due to factors such as temperature changes, autonomic nervous system reactions, and taking cold medicine. Especially acute urinary retention, where urine does not come out at all, is an emergency situation that can threaten bladder and kidney functions, so it should never be neglected." He added, "What matters in BPH treatment is identifying exactly how the prostate has transformed toward the inside of the bladder rather than its size. If median lobe protrusion is accompanied, it is helpful for long-term preservation of voiding function to consider treatment like HoLEP surgery that can fundamentally improve the bladder outlet at the appropriate time rather than relying solely on medication."