Benign prostatic hyperplasia (BPH) is a common condition in middle-aged and older men that can significantly reduce quality of life. When accompanied by bladder stones, symptoms and discomfort may become even more severe. Understanding the condition and selecting the appropriate treatment are essential for recovery.
The prostate is a walnut-sized organ found only in men, and it tends to enlarge with age. This enlargement, known as BPH, can obstruct urine flow. When urine is not emptied properly, the risk of bladder stone formation increases.
A recent case illustrates both the severity of this condition and its treatment options. One patient was found to have a prostate volume of 86 grams. Considering that the average prostate size is approximately 20 grams, this was about four to five times larger than normal. Ultrasound imaging showed that the enlarged prostate was protruding into the bladder, and multiple bladder stones of varying sizes were also identified.
In such cases, holmium laser enucleation of the prostate (HoLEP) is an effective treatment option. One of the main advantages of HoLEP is that it can address both BPH and bladder stones simultaneously. The holmium laser is highly effective for removing enlarged prostate tissue while also fragmenting and eliminating bladder stones. Because the laser breaks stones into small fragments that can be naturally expelled, HoLEP is particularly suitable for patients with both conditions. As a result, many patients experience high satisfaction and significant improvement in urinary symptoms after the procedure.
Interestingly, not all urinary symptoms are caused by prostate enlargement. In some cases, patients may experience frequent urination or difficulty voiding even when the prostate is not significantly enlarged. One possible cause is urethral stricture, a condition in which the urethra becomes narrowed, restricting urine flow.
Laser treatment can also be used to manage urethral stricture. The narrowed segment is widened using a laser, and a stent is inserted to maintain patency. In one recent case, a severely narrowed urethra—reduced to nearly the diameter of a needle—was successfully treated using this method. Before surgery, the patient’s maximum urinary flow rate (Qmax) was 4.1 mL/s. After the procedure, it improved dramatically to 37.8 mL/s, nearly a tenfold increase. Considering that the average Qmax in adult men is typically around 15 to 20 mL/s, this represents a significant improvement. The patient was able to walk out of the hospital on the same day, expressing surprise at the immediate improvement in urinary function.
Treatment options for urinary disorders such as BPH continue to evolve. Even after more than 20 years of clinical practice, ongoing learning and adoption of new medical technologies remain essential to providing better care. Creating an environment where patients can comfortably seek consultation and receive appropriate treatment is a priority. Continued efforts will be made to improve outcomes and enhance quality of life for patients experiencing urinary symptoms.