Benign prostatic hyperplasia (BPH) is a urological condition that significantly reduces the quality of life in middle-aged and older men. When accompanied by bladder stones, the symptoms and discomfort can become even more severe. For this reason, it is important for patients to visit a medical institution for timely evaluation and treatment when symptoms are suspected.
The prostate is a walnut-sized gland found only in men and tends to enlarge gradually with age. As the prostate grows, it can compress the urethra and make urination difficult. When urine does not flow properly, the risk of bladder stone formation may also increase.
In some cases, prostate enlargement becomes particularly pronounced. The average prostate size is generally around 20 grams, but in cases of severe enlargement the gland may grow beyond 80 grams, which is considered a significantly enlarged prostate.
In such cases, holmium laser enucleation of the prostate (HoLEP) can be an effective treatment option. One of the main advantages of HoLEP is that it can address both benign prostatic hyperplasia and bladder stones at the same time. The holmium laser can precisely remove enlarged prostate tissue while also fragmenting and removing bladder stones. Because the laser can break stones into small pieces that are easily removed or naturally expelled, this method is particularly suitable for patients with BPH accompanied by bladder stones. As a result, many patients report high satisfaction and significant improvement in urinary symptoms after the procedure.
However, it is important to note that not all urinary symptoms are caused by prostate enlargement. In some cases, patients may experience symptoms such as frequent urination even when the prostate is not significantly enlarged. These symptoms may instead be caused by other conditions, such as urethral stricture. Urethral stricture occurs when the urethra becomes narrowed, making it difficult for urine to pass through.
Laser technology can also be used to treat urethral strictures. In this approach, the narrowed portion of the urethra is widened using a laser, and a stent may be inserted to maintain the widened passage.
In a recent case, a urethra narrowed to nearly the size of a needle was successfully widened using laser treatment followed by stent insertion. Before the procedure, the patient’s peak urinary flow rate was only 4.1 mL per second, but after treatment it increased to 37.8 mL per second—almost ten times faster. Prior to surgery, urine flow had been severely restricted due to the narrowing of the urethra, but it improved significantly after the procedure. Considering that the average peak urinary flow rate in adult men is typically reported to be around 15 to 20 mL per second, this represented a substantial improvement. The patient was so satisfied with the outcome that he was able to walk out of the hospital and be discharged on the same day.
Treatment methods for urinary conditions such as benign prostatic hyperplasia continue to evolve, reflecting ongoing efforts in the medical field to provide better care for patients. Continued research and clinical innovation are expected to further reduce patient discomfort and improve treatment outcomes in the future.
Dr. Ryu Kyung-ho
Goldman Urology Clinic, Gangnam Branch