As men age, frequent urination, weak urine flow, or waking up several times at night to urinate should not simply be dismissed as a normal part of aging. These symptoms may indicate benign prostatic hyperplasia (BPH).
BPH occurs when the prostate enlarges and compresses the urethra, making urination difficult. Although it is a very common condition—affecting more than half of men over the age of 60—leaving it untreated can lead to decreased bladder function, bladder stones, urinary tract infections, and even kidney damage.
In the early stages, BPH can often be managed with medication. However, over time the medication may become less effective, side effects may develop, or symptoms may worsen. In such situations, surgical treatment may be necessary. Fortunately, this does not always mean undergoing a major surgery. Recently, minimally invasive surgical treatments (MIST) that place less strain on the body and allow faster recovery have gained increasing attention. Below is a question-and-answer overview of treatment options that many patients are curious about.
What is MIST?
MIST refers to treatment methods that are less invasive than traditional surgery, meaning they minimize physical damage to the body. Most procedures can be performed under local anesthesia or mild sedation without general anesthesia. Hospitalization is usually unnecessary or very short, and recovery is typically quick. Because these procedures have minimal impact on daily life, they are particularly beneficial for working individuals and elderly patients.
What are the main types of MIST treatments?
1. Water Vapor Thermal Therapy (Rezum)
This treatment involves injecting high-temperature water vapor into the prostate tissue, causing the enlarged tissue to undergo necrosis and gradually shrink. The procedure can be performed under local anesthesia, usually takes less than 10 minutes, and allows for rapid recovery. It also has a high rate of sexual function preservation. Many hospitals in Korea already perform this procedure, and its safety and effectiveness have been well demonstrated.
2. Prostatic Urethral Lift (UroLift)
This method does not remove prostate tissue. Instead, special implants are used to pull the enlarged prostate lobes aside, widening the prostatic urethra. Because the procedure is performed without incisions and generally preserves sexual function, it may be a good option for patients who are particularly concerned about complications such as retrograde ejaculation.
3. Temporary Implanted Nitinol Device (iTind)
This minimally invasive procedure widens the narrowed prostatic urethra using a temporary device made of nitinol. The device remains in place for about five to seven days before being removed. Even after removal, the prostatic urethra remains widened, allowing urine to flow more normally. Although it is a relatively new technique, early results have been promising and its use is expected to expand in the future.
How does MIST differ from traditional surgery?
The most well-known traditional surgical procedure is transurethral resection of the prostate (TURP). While TURP has long demonstrated strong clinical effectiveness, it may involve risks such as bleeding, infection, and retrograde ejaculation, and typically requires hospitalization and general anesthesia. In contrast, most MIST procedures can be performed on an outpatient basis, involve faster recovery, and have significantly lower rates of sexual side effects.
Who is a suitable candidate for MIST?
MIST treatments are not suitable for every patient with BPH. Factors such as prostate size, prostate shape, and the severity of symptoms must be carefully evaluated by a urology specialist. Patients with very large prostates, significant middle lobe enlargement, or already developed bladder dysfunction may still be better suited to conventional surgical approaches. For example, UroLift is generally not recommended when the middle lobe is significantly enlarged, and Rezum may not produce sufficient results for extremely large prostates. Proper patient selection is therefore essential.
Conclusion: consultation comes before choosing a treatment
BPH is not a condition that should simply be tolerated or ignored. If left untreated, it can significantly reduce quality of life and may lead to serious health complications. Fortunately, a variety of treatment options are now available, allowing patients to choose the approach best suited to their individual condition. If you notice symptoms such as weak urine flow or frequent urination, it is advisable to visit a urology clinic for consultation before the condition progresses. With early diagnosis and appropriate treatment, it is possible to maintain a good quality of life.