BPH Management: Patient Outcome Evolution

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Evolution of BPH Treatment Outcomes

Dr Christopher Kelly discusses the evolution of patient outcomes with different benign prostatic hyperplasia (BPH) treatments, particularly focusing on ejaculation preservation and durability.

• Early concerns (2010s): He prioritized ejaculation preservation and found UroLift and Rezūm beneficial for this purpose. However, these treatments lacked long-term durability, leading to earlier retreatment needs.
• Transition to modified TURP and GreenLight: To improve durability, he adopted ejaculation-sparing GreenLight laser and transurethral resection of the prostate (TURP). While ejaculation was better preserved, many patients experienced urinary retention due to residual obstructive tissue, sometimes requiring additional surgery.
• Holmium laser experience: Initially, holmium laser procedures resulted in significant urinary incontinence. However, with technique refinement, incontinence decreased, and patients improved with pelvic floor exercises.
• Aqua ablation (2018 onward): Marked a significant improvement in both ejaculation preservation and durability. Patients experienced minimal need for retreatment even after 5 years, an outcome unmatched by prior techniques.

Dr Kelly highlights aqua ablation as the most effective method for maintaining ejaculation while ensuring long-term treatment success.