Most men over middle age have heard of benign prostatic hyperplasia (BPH) at least once. BPH refers to the gradual enlargement of the prostate gland that occurs as part of the aging process. The problem is that an enlarged prostate can cause urinary difficulties that significantly affect quality of life. When conditions such as bladder stones or urethral stricture occur together, symptoms can become more complicated and treatment may also become more challenging.
The prostate is a gland located beneath the bladder in men and plays a role in producing a portion of semen. On average, the prostate weighs about 20 grams, but it tends to increase in size as men age. When the prostate enlarges, it can compress the urethra—the channel through which urine flows—leading to urinary problems. Typical symptoms of BPH include a feeling of incomplete bladder emptying after urination, frequent urination, nighttime urination, and a reduced urinary stream.
When urine cannot be fully expelled from the bladder, residual urine may remain inside the bladder. Over time, this can lead to the formation of bladder stones. When multiple problems occur together, symptoms become more severe and the need for treatment becomes more urgent.
In such situations, one treatment that has gained attention is holmium laser enucleation of the prostate (HoLEP). HoLEP is a surgical procedure that uses a holmium laser to remove enlarged prostate tissue. One of the advantages of HoLEP is that it can treat both BPH and bladder stones at the same time. The holmium laser can precisely remove prostate tissue while also breaking bladder stones into small fragments that can be naturally expelled. For patients experiencing multiple urinary problems, this makes HoLEP a particularly effective treatment option.
However, not all urinary symptoms are necessarily caused by BPH. Even when the prostate size is normal, similar symptoms can occur due to other conditions such as urethral stricture. Urethral stricture refers to a narrowing of the urethra that may occur as a result of injury, inflammation, or previous surgery. One characteristic symptom is an extremely thin urinary stream, sometimes described as being as narrow as a needle.
In recent years, urethral stricture can also be treated using laser technology. The narrowed section of the urethra is carefully incised with a laser, and a stent may be inserted to maintain a wider urethral diameter.
Dr. Ryu Je-man of Goldman Urology Clinic’s Seoul Station branch explained that although conditions such as BPH, bladder stones, and urethral stricture can produce similar symptoms, their underlying causes are different. Therefore, accurate diagnosis and a carefully planned treatment strategy are essential. He also noted that laser-based procedures offer advantages for many middle-aged and older patients because they involve less bleeding and pain and allow faster recovery. Rather than making assumptions based solely on symptoms, identifying the exact cause and selecting the most appropriate treatment is the key to effective care.